For Participants NOT 18 years old

Infant Participant’s Name:__________________________________________Date of Birth:_________

Infant's Address: ________________________________________ City:________________________

Prov._____________________ Postal: ______________


Parent/Guardian Name: _______________________________________ Date of Birth: _____________


Parent/Guardian Address: _________________________________ City: ________________________

Prov: ____________________ Postal:_______________


The Parent/Guardian must Read and Understand this form before Infant Participating in Equine Activities

To:__________________________their directors, employees, volunteers, business operators, and site property owner.
(Name of Person, Organizatiion or Company Providing the Equine Activity)                                                            (all of them collectively called the HOST)

Initial each item below After Reading and Understanding The Item


_____ 1.  I am the Parent/Legal Guardian of the infant Participant Understand named above and an am executing this form on behalf of the infant Participant in my capacity as parent and/or guardian and with the intent that this form be binding on myself and infant Participant for all legal purposes.


_____ 2. I Understand there are inherent DANGERS, HAZARDS, AND RISKS, (collectively called RISKS) with Equine Activities and injuries resulting from these “RISKS” are a common occurrence.


_____ 3.  I Acknowledge that the Inherent “RISKS” of Equine Activities and those DANGEROUS conditions are an integral part of Equine Activities, including but not limited to:

* The propensity of any equine to behave in ways that might result in injury, harm or death to persons around them and to potentially collide with, bite or kick other animals, people or objects.

* The unpredictability of an equine’s reaction to such things as sounds, sudden movement, termors, unfamiliar objects, persons or other animals and hazards such as subsurface objects.

* The potential for other participant(s) to act in a negligent manner that might contribute to injury to themselves or others, such as failing to act within their ability or to maintain control over an equine.


_____ 4.  I Freely Accept and Fully Assume All Responsibility for the Inherent “RISKS” and the possibility of personal injury, death, property damage or loss resulting from my Participating in Equine Activities.


_____ 5.  I Acknowledge that it remains my Sole Responsibility to act in such a manner as to be responsible for my own safety and to Participate Within My Own Limits.


_____ 6.  In addition to consideration given for the infant to Participate in Equine Activity, I and my heirs, executors, administrators and assigns (collectively called my “Legal Representatives”) agree

                                * To Waive All Claims that I or the infant Participant might have against the “HOST”; and

* To Release the “HOST” for Any and All Liability for any loss, damages, injury, or expenses that I, the infant Participant or our “legal Representatives” might suffer as a result of the infant's Participation due to any cause including any NEGLIGENCE ON THE PART OF THE “HOST” and

* To HOLD HARMLESS AND INDEMNIFY THE “HOST” from any and all liability for any damage or personal injury to the infant Participant or to any third party which might result from the infant's Participation.

Before signing this form I read it (as indicated by my initials above) and I state that I understand it. I know that signing this form, waives certain legal rights I and/ or the infant Participant and/or our “Legal Representatives” might have against the “HOST”.

SIGNED This ____________________________ day of ________________________20_____

_______________________________________        __________________________________

 (Print Name of HOST Witness to signing and Initialling)                           (Signature of Participant)


_______________________________________        __________________________________

 (Signiture Host Witness)                                                                                    (Signature of Parent/Guardian)

Do Not Sign until you Understand All Items Above