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HORSES 101

MEDICAL & LIABILITY RELEASE WAIVER

CAUTION: PLEASE READ CAREFULLY BEFORE SIGNING

PARENTS/GUARDIAN MUST SIGN FOR MINOR CHILDREN

CAUTION:  Be Advised That Equine Activities Take Place On The Premises And That All Equine Activities Can Involve Inherent Risks Despite All Safety Precautions.  Participate At Your Own Risk At All Times.

Be it hereby known:

“Inherent risks of equine activities” shall mean those risks, dangers or conditions which are an integral part of equine activities, including, but not limited to:

(a)          The propensity of any horse to behave in unpredictable ways that may result in injury, harm or death to persons on or around them, and/or damage to property in their vicinity, and whether the person is walking nearby, mounting, riding or dismounting;

(b)          The unpredictability of a horse’s reaction to such things as sights, lights, man-made or Mother Nature’s sounds, sudden movement, unfamiliar objects, persons, other animals and reptiles, and the inherent tendency to bite, bolt and run, stampede, trample, step on a person, push against a person, buck or throw the rider, or rear up and fall on a person;

 (c)          There are other inherent risks other than those listed above, obvious and not obvious, and the undersigned guardian of minor acknowledges that this release and exculpatory agreement is not confined to the above list, but shall be liberally construed to include any possible risk or combination of risks possible relating to equine activities.

In consideration that I will be allowed to participate in any horse related activities that Miller Horse Farm provides, I do hereby agree that in the event I am injured or any of my party, friends, relatives, or horses are injured or suffer personal injury or property damage during my stay, that I will not, in any event, hold responsible nor present any claims or demands to Miller Horse Farm, its owners, Noah Smith, and individually, Glory Smith, Joy Fowler, Ellen Haver, Melissa Rexroad, and Deirdre Strook as the instructors, directors, officers, agents, representatives, employees and volunteers, on account of any injury that I, or any of my party may have suffered. 

MHF Code of Conduct: Miller Horse Farm “Horse 101” Camp encourages a safe and healthy atmosphere. Children must follow all instructions of MHF staff. MHF reserves the right to refuse a child to ride a horse or engage in equine activities if he/she does not follow the instructions given or behaves in a way that endangers his/her safety. MHF reserves the right to refuse a child to return for any of the above mentioned behaviors that will endanger the child/children or instructor’s safety. No refunds will be given. Any use of MHF facility is at OWN RISK!

All participants will use a riding helmet and must be able to safely engage in equine activities.  MHF is not responsible for an injury or death of a participant in MHF activities. In consideration of my child’s participation in the sponsored activity, I hereby release, hold harmless, and discharge MHF, its elected officials, officers, employees, agents, representatives, and assignees from any and all claims for personal injuries and damages. Parent, or legal guardian, agrees to pay legal fees incurred by MHF in defense of any claim made by parent, or legal guardian, against MHF.

I have read and agree to the MHF Code of Conduct and accept responsibility for any acts on behalf of my child in violation of this code.

I Agree

I understand that travel to and from and participation in horse related activities, including horseback riding, have inherent dangers that could result in property damage, severe personal injury, including a serious accident or loss of life, no matter how well the activity is supervised. I accept full responsibility for all minors brought to Miller Horse Farm by me or anyone that I have authorized for child pick-up, even if they are not participating in the farm activities. I certify that I have adequate insurance to cover any injury or damage that I or my minor(s) may cause or suffer while participating or else I agree to bear the costs of such injury or damage. I further certify that my minor has no medical or physical condition which could interfere with his/her safety in these activities. Also I accept full responsibility for Risks, known and unknown and I agree to indemnify Miller Horse Farm and all of their owners, Noah Smith, directors, officers, agents, representatives, employees and volunteers; and individually, Glory Smith, Joy Fowler, Ellen Haver, Melissa Rexroad, and Deirdre Strook as the instructors, and also landowners and adjacent landowners, and other local government/city agencies with whom the previously mentioned parties contract or do business, from any costs or liability associated with any accident or illness involving the below named rider or any guest or member of my family.  This Waiver and Release also applies to claims arising out of, or relating to, negligence by Miller Horse Farm. 

I do hereby for and on behalf of myself, my minor child, and my heirs release and forever discharge Miller Horse Farm, their owners, directors, officers, agents, representatives, employees and volunteers, and individually Glory Smith, Joy Fowler, Ellen Haver, Melissa Rexroad, and Deirdre Strook as the instructors, and other local government/city agencies with whom the previously mention parties contract or do business from any and all claims and demands of every kind, nature and character which I or my minor child may have, or may hereafter acquire, for any and all damages.  Losses or injuries, or death, which may be suffered or sustained by me or my minor with any activities in any way related to the afore mentioned and all such claims are hereby waived and released, and I covenant not to sue therefore.  I understand and fully assume all risks and hazards incidental to horseback riding and related activities.

I Agree

AUTHORIZATION FOR MEDICAL TREATMENT

I hereby authorize any medical treatment deemed necessary in the event of any injury to my minor(s) while participating in horseback riding or any activity offered by Miller Horse Farm. I either have appropriate insurance or, in its absence, agree to pay all costs for medical services as may be incurred on my minor(s) behalf.

I Agree

PHOTO RELEASE: I give permission for photographs taken of me or my minor while participating in this activity to be used in marketing and/or public relations material.

I Agree

By signing this document, I acknowledge that if my minor(s) is hurt or property is damaged during his/her participation in this activity, I may be found by a court of law to have waived my right to maintain a law suit against Miller Horse Farm on the basis of any claim from which I have released Miller Horse Farm herein.

I Agree

The Participant hereby voluntarily enters into this Contract and Agreement this date: May 8, 2024

THIS IS BINDING LEGAL AGREEMENT AFFECTS IMPORTANT LEGAL RIGHTS.  I HAVE READ AND UNDERSTOOD THIS DOCUMENT AND AGREE TO BE BOUND BY IT.  Parent /Guardian’s Initial:


 

First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Medical/Allergies/Health Concerns:
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Medical/Allergies/Health Concerns:
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Medical/Allergies/Health Concerns:
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Medical/Allergies/Health Concerns:
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Medical/Allergies/Health Concerns:
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Medical/Allergies/Health Concerns:
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Medical/Allergies/Health Concerns:
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Medical/Allergies/Health Concerns:
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Medical/Allergies/Health Concerns:
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Medical/Allergies/Health Concerns:
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Insurance Information

Medical Insurance Co.: *

Policy #: *

Doctor's Name: *

Phone: *

Hospital Preference: *
Primary Emergency Contacts

In case of emergency, all attempts will be made to contact one of the persons listed below as soon as possible.


Name: *

Phone: *

Relationship to child: *

Name:

Phone:

Relationship to child:
Child Pick Up Authorization:

Name: *

Phone: *

Relationship to child: *

Name:

Phone:

Relationship to child:
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Medical/Allergies/Health Concerns:
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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