EMERGENCY CONTACT INFORMATION
agree to the following:
1. Waiver and Release: I am fully aware of and appreciate the risks, including the risk of
catastrophic injury, paralysis, and even death, as well as other damages and losses, associated
with participation in a horse-related event and related activities. I further agree
on behalf of myself, my heirs and personal representatives, that Autumn O'Hara along with Ride-On Ranch or Belisle Corp. volunteers, employees, agents, sponsors, officers,and directors of these organizations, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my participation in the event.
2. Medical Attention: I hereby give my consent to Ride-On Ranch to provide,through a medical staff of its choice, customary medical attention,
transportation and emergency medical services as warranted in the course of my participation
in Ride-On Ranch sponsored or sanctioned events.
3. Readiness to Participate: I will only participate in those activities in which I
believe I am physically and psychologically prepared to participate.
As legal guardian of this participant, I hereby verify by my signature below that I have read and
fully understand each of the conditions under Participant Waiver and Release section for permitting my
child to participate in any Ride-On Ranch sponsored events and activities and I accept each
of the conditions, especially the waiver and release set forth in paragraph one.
All participants are required to be covered with insurance for accidental injury. In most instances, family
health insurance is adequate. Please indicate your family health insurance plan above.
Medical Treatment Authorization
I/We being the legal guardians of the applicant authorize Ride-On Ranch and its agent’s
permission to request medical treatment as necessary to insure the well being of our dependent.
In consideration of receiving permission from the Ride-On Ranch Equine Assisted Therapies (referred to as "The Ranch”)
to participate in or observe hippotherapy treatment sessions, adaptive riding sessions, research projects, horseback riding lessons or a similar session and in further consideration of receiving permission to enter upon the premises of property or other premises upon which The Ranch’s sessions may be conducted, the undersigned and his/her family and hereby forever release, acquit, discharge and holds harmless The Ranch, as well as its officers, governors, staff,agents instructors, volunteers, contributors and any property or horse owners affiliated with The Ranch of and from any and all liabilities, claims, any loss, damage, illness, injury, or death that may be sustained by any or each of the undersigned while in on or upon the premises while participating in or observing any session or while en route to or from these premises.
The undersigned acknowledges that there are certain risks inherent in participation in equine activities including (i) the propensity of an equine to behave in dangerous ways that may result in injury to the participant: (ii) the inability to predict an equine’s reaction to sound, movements, objects, persons, or animals:(iii) the possibility of equipment failure and (iv) hazards of surface or subsurface conditions. While The Ranch makes every effort to minimize these risks, the undersigned is duly aware of these risks and hazards inherent upon participation in or observing equine activities and/or upon entering upon said premises. The undersigned also agrees to represent the potential for these hazards to others that may accompany or substitute for him/her at activities sponsored by The Ranch. These persons also, by their voluntary presence, assume the same risks and agree by their presence to the same release of liability described herein.
The undersigned and all others that may accompany, represent, and/or substitute for those persons agrees to indemnify and will hold harmless The Ranch, its officers, trustees, agents, instructors, volunteers,contributors, and other property and horse owners from any and all costs, charges,claims, demands, and liabilities of any kind arising either from the improper or negligent use by those listed and all that may accompany, represent, and/or substitute for those listed below of any equine, bridle, saddle, grooming tool, and/or other animal or tool or from the willful or negligent acts of said persons.
For valuable consideration given and which is hereby acknowledged, the undersigned hereby grants permission to Ride-On Ranch to take or have taken, still and moving photographs and films including television pictures of my daughter/son/ward/self and consents and authorizes Ride-On Ranch, news media, and any other persons interested in the subject of equine activities for individuals with disabilities and its work, to use and reproduce the photographs, films and pictures and to circulate and publicize the same by all means including and without limiting the generality of the foregoing newspapers, television media, brochures, pamphlets, books, social media including Facebook, instructional material and clinical material.
With respect to the foregoing matters, no inducements or promises have been made to me to secure my signature to this release other than the intention of Ride-On Ranch to use or cause to be used such photographs, films, or pictures for the primary purpose of promoting and aiding the field of riding for individuals with disabilities and its work.
Participant Release of Belisle Corp
BelisleCorp. for consideration received and in return for permission for Participant to enter the property known as Belisle Corp. Participant and Participant’s heirs, assigns, and representatives hereby agree as follows:
1. Participant understands and agrees that BelisleCorp. is an equine facility at which horses are present and at which equine activities are conducted. Participant understands and agrees that there are intrinsic dangers arising from equine activities,including but not limited to, (i) the propensity of equines to behave in ways that may result in injury,harm, or death to persons on or around them; (ii) the unpredictability of an equine’s reaction to such things as sounds, sudden movement, and unfamiliar objects, persons, or other animals; (iii) certain hazards such as surface and subsurface conditions; (iv) collisions with other animals and objects; (v) the potential of a person (including Participant)acting in a negligent manner that may contribute to injury to the Participant or others, such as failing to maintain control over an equine or not acting within the person’s ability; and (vi) weather conditions including, but not limited to rain, snow, ice,wind, or heat. Participants are aware of Virginia State Law - Va. Code Ann. § 3.2-6200 – 6302– comprising of equine activities.
2. Participant agrees to assume any and all risks involved in or arising from participating including,but not limited to, risks of bodily injury, death, property damage, falls, kicks, bites, collisions with vehicles, movingor stationary objects, limited emergency medical availability, or the negligence or deliberate act of any other person.
3. Participant agrees to hold harmless, indemnify and defend Belisle Corp. against, and hold harmless from, any and all claims, demands, causes of action, damages, judgments, orders, costs or expenses,including attorney’s fees, whether actually incurred or not, which may in any way arise from or be in any way connected to Participant’s activities at or presence upon the Farm.
4. Participant acknowledges and agrees that it is Participant’s responsibility to determine that the premises are suitable for Participant’s activities. Participant acknowledges and agrees that Belisle Corp. and make no representation or warranty that the premises (including, but not limited to, rings, pastures, jumps, barns, and fences) are suitable or safe for Participant’s activities. Participant understands and agrees that Participant is present on BelisleCorp.’s at Participant’s own risk.
5. If Participant is present as a spectator, Participant understands and agrees that the sole area Participant may occupy for such purposes is the parking area at the north end of the indoor arena or such other area designated for spectator use by Belisle Corp.
6. Participant agrees to waive the protection of any and all applicable statutes in this jurisdiction the purpose, substance and/or effect of which is to provide that a general release of liability shall not extend to claims, material or otherwise, which the person does not know or suspect to exist at the time of executing said release.