Safety Equipment Acknowledgment Release Form

(For Participants Under theAge of Majority)

Clinic Dates:

Infant Participants Name:

Clinic Location:

Infant Date of Birth:

Infant Participants Address:

Parent/Guardian's Name:

Parent/Guardian Date of Birth:

Parent/Guardian Address:

No person riding without a helmet designed for equine activities will be allowed to participate in equine activities prior to reading and signing this form. Parent/Guardian must Read and Understand prior to the Infant Participating in Equine Activities

TO: The Horse Ranch 2005 Inc. / Glenn Stewart (Also known as “HR” for this document)

ACKNOWLEDGMENTS AND STATEMENTS OF PARENT/GUARDIAN

Check each box below after Reading and Understanding each item:

1) I am the Parent or Legal Guardian of the infant Participant named above and am executing this form on behalf of the infant Participant in my capacity as parent or guardian with the intent this Form Is To Be Binding on Myself and the Infant Participant for All Legal Purposes.

2) I Understand the RISKS inherent in equine activities as evidenced by the separately signed Acknowledgment of Risk and Release of Liability Form on file with the “HR”.

3) I Understand injury may be reduced by wearing proper safety equipment and that no amounts of preplanning can remove all the DANGERS, HAZARDS, AND RISKS of equine activities.

4) I have Freely Decided to allow the infant Participant to ride without wearing a helmet designed for equine activities which might prevent permanent brain damage in the event of an accident.

5) I have permitted the Refusal of Critical Safety Equipment against the advice of the “HR”

6) I Assume Full Responsibility for all additional DANGERS, HAZARDS, AND RISKS of injury my decision to permit riding without a helmet might expose the infant Participant.

7) I Agree to HOLD HARMLESS and INDEMNIFY the “HR” from any and all liability for injury resulting from the infant Paricipant riding without a helmet designed for equine activities.

8) I Understand that signing this form Waives certain Legal Rights that I or the infant Participant might have against the “HR”.

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

Do Not Sign until you Understand All Items Above

Name of Parent/Guardian

Signature Of Parent/Guardian

Thank your for Submitting your Form

Mission Acres

Equestrian Center

Est. 2018