**Please print and bring one completed form for each adult & a form for each minor signed by a guardian

 

Cedar Island Stables or ETT Properties, LLC

Release of Liability  –  Read Before Signing

In consideration of being permitted to participate in any way with Cedar Island Stables or ETT Properties, LLC, its related events, activities, furnishing of services and/or equipment to enable me to participate in Cedar Island Stables or ETT Properties, LLC, I the undersigned, understand, acknowledge, and agree that:

  1. Horseback Riding, Trail Riding or guide related services involves inherent hazards, dangers, risks, and associated with the dynamic and unpredictable environment where horseback riding activities are held. Participants can be injured walking or climbing on or around the horse, getting on to or out of all of any horse, mounting stand or other any other areas around the horse facilities and at other times and locations. Sunburn, wind, rain, lightning, riding, running or being in the open for extended periods may be uncomfortable or cause injury. Certain insects, plants or animals may cause discomfort or injury.

I recognize that all hazards cannot be foreseen or controlled and this is not an exclusive or exhaustive list of possible ways to get injured.  Injuries may occur as a result of my negligence, the negligence of others, or through no fault of my own or anyone else, because of the nature of the activity.  The risk of injury from Horseback Riding, Trail Riding or guide related services and any activity involving land and water may be significant, including the potential for injury or death.  Cedar Island Stables or ETT Properties, LLC does not have control of all the risks involved;

Risks and dangers may arise from foreseeable or unforeseeable causes including, but not limited to, guide decision making, including that a guide may misjudge terrain, weather, trail or river route location, and water level, risks of falling off of or drowning while crossing or entering bodies of water and such other risks, hazards and dangers that are integral to recreational activities and /or use of animals or equipment;

  1. My participation in such activities and/or use of such equipment may result in injury or illness including, but not limited to bodily injury, disease, strains, fractures, partial and/or total paralysis, death, or other ailments that could cause serious disability;
  2. I assume full responsibility for my own actions and for my voluntary decision to participate. I knowingly, freely, and expressly assume all risks, both known and unknown, of injury or death or damage or loss of personal property, even as a result of my negligence; negligence of my family or the negligence of those persons released from liability below;
  3. I will comply with all rules and regulations. If I have any questions or observe an unusual and unnecessary hazard during my participation.  I will immediately bring such to the attention of the nearest official;
  4. I for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release indemnify, and hold harmless Cedar Island Stables or ETT Properties, LLC, the owners, lessors and lessees of premises used to conduct all activities, their directors, officers, officials, instructors, guides, volunteers, agents, and/or employees (“releasees”).  WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property, whether or not caused by the releases;

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

 

_________________________________________________                      __________________________________________________________

Printed Name                                                                                    Guardians Name (If participant is a minor)

 

_________________________________________________                     ___________________________________________________________

Participants Signature                           Date                                    Guardian’s Signature                           Date

 

 

 

Cedar Island Stables or ETT Properties, LLC

Outdoor Adventures are a physically demanding activity that comes with risks.  In the event of an emergency, having the correct information and history on hand and being able to get it into the hands of health care providers quickly could be the difference between life and death.  This information will be kept confidential.

Name:_________________________________________ Age:______Gender: ______ Height: __________ Weight: _________

Emergency Contact Person: _______________________________________________ Relationship: ______________________

Day phone: _____________________________________   Evening Phone: __________________________________________

Health Insurance carrier __________________________________________  Policy number: ____________________________

Medical Information (Check all that apply):

□ Diabetes   □ High Blood Pressure   □ Asthma   □ Epilepsy   □ Stroke   □ Heart Disease   □ Chest pain with physical exertion

□ Back Problems   □ Wrist/Elbow/Shoulder problems   □ Hip/Knee/Ankle problems  □ Currently Pregnant  □ Smoker

Have you ever had a heart attack or stroke? ________    Do you have lung disease or a breathing disorder? _________

Have you ever had an allergic reaction? ________  If yes, to what? _____________________  Do you carry an epi pen? _______

Are you currently under a doctor’s care? ________  If yes, for what condition?________________________________________

Are you currently taking any prescription medication? ________  If yes, please list: ____________________________________

Have you undergone surgery within the last 12 months? ________  If yes, please explain: _______________________________

Have you been advised by a healthcare provider not to engage in vigorous physical activity? ________

Do you have any dietary restrictions or food allergies? ___________________________________________________________

Overall Health Questionnaire:

How often do you exercise?  □ Daily  □ 2-3x/week   □ Rarely        For how many minutes do you exercise? _________________

Please give a brief, but accurate description of your general health and weekly activity level: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please describe anything else about your physical or emotional condition that could impact your ability to engage in a strenuous physical activity, or anything else that we should know to make your time in class a better learning experience: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I affirm that my health is good and that the above information is accurate and complete.

 

Signature: _________________________________________________       Date: _____________________________________

Printed Name: ______________________________________________