AGREEMENT FOR RELEASE AND LIABILITY (printable form)

 

I request permission to participate in the 17 Km Ride-&-Hike-a-Thon sponsored by the Lanark County Therapeutic Riding Program Society  Saturday October 9th 2010.  I fully understand that Cross-Country Riding (which includes riding over and around some obstacles, steep and rough terrain) is a risk  activity.  I wish to participate in this activity knowing that it is a risk.  I accept and assume all the risks of injury (including death) to me and my property.

 

In exchange for being permitted to participate in this activity, for myself, my heirs, guardians, and legal representatives, I release and agree not to make or bring any claim of any kind against Lanark County Therapeutic Riding Program or its executives, employees or guest of any land owners, landholders, or other persons making property available for this activity, for injury (including death), to me or any damages to my property whether from anyone’s negligence or not, or any other cause, arising out of my participation; in these dangerous horseback riding or related activities; and I also agree if anyone makes any claims because of any injury to me (including death), or for any damage to my property, I will keep all those released by this agreement free of any damages or costs because of those claims.

 

Printed Name:  

Address: _____________________________________

 

 Postal Code:   _________   Dated: ________________    

 Signature: X__________________________________

 

Proof of Liability Insurance:

Insurance Company: __________________________________________________

 

Address: ___________________________________________________________

 

Policy Number: _________________________________   

Expiry Date (MM/DD/YYYY): _______________________