This Release form must be signed by anyone coming onto the facility with the exception of equine professionals performing services on site.  Forms are available in the grooming barn breezeway.

 

COMPLETE RELEASE OF LIABILITY FOR INJURY OR ILLNESS OR PROPERTY DAMAGE                                                                                                                                                                            

 

The undersigned states as follows:

            I acknowledge that competitive and pleasure horse riding and handling contains inherent risks of injury and damage to me personally, to bystanders, to the horses involved, to my equipment and to other property.  Knowing these facts, I nevertheless, in consideration of your acceptance of this form and access to your premises, hereby for myself, my agents, representatives, heirs, successors, assignees, executors, and administrators waive, release and discharge and hold harmless William J. Erkelens and Marie L. Roehm individually and dba American Canyon Training Center and their representatives, employees, heirs, successors, executors, administrators, agents and assigns from any and all right, claim, or liability for damages or for any and all injuries or loss that might be sustained by me, my guests, my agents, my invitees, my horse, or my other property and from any and all claims of any kind or nature that I, my guests, my agents or my invitees might have as result of, or arising out of any activity relating to transporting, boarding, riding or handling my horse or any other horse present, stabled or being used at 2130 American Canyon Road, including but not limited to any damages, injuries or loss caused in whole or in part by any negligence of American Canyon Training Center, William J. Erkelens, Marie L. Roehm or their employees and representatives.  Further, I do hereby acknowledge that this release and hold harmless will extend to any accidents, injuries, loss, damages or claims of others arising out of my presence and/or participation, caused by my horse or my own act or the acts of anyone or any animal or anything within my control or for which I am responsible, including but not limited to any damages, injuries or loss caused in whole or in part by any negligence of American Canyon Training Center, William J. Erkelens, Marie L. Roehm or their employees and representatives.  I further agree that I will defend, indemnify and hold harmless the American Canyon Training Center, William J. Erkelens, Marie L. Roehm and their representatives, employees, heirs, successors, executors, administrators, agents and assigns against any and all claims, demands and causes of action including court costs or other costs of dispute resolution and attorneys fees, directly or indirectly arising in whole or in part from any action or other proceeding brought by or prosecuted for my benefit or that of my guests, agents, heirs, successors, assign or representatives contrary to this Release.  I understand that this Release extends to all claims of every kind and nature whatsoever, whether known or unknown, suspected or unsuspected, and I expressly waive any benefits I may have under California Civil Code section 1543 relating to the release of any unknown claims.

 

            I acknowledge that I have read the foregoing and know and understand the content thereof.

Signed:  ________________________        Date:  ______________________

Name (in print) _________________       County where signed:  __________

 

HORSES CAN BE DANGEROUS!

A HORSE OR HUMAN CAN BE HURT ANYTIME, ANY PLACE!

PLEASE BE CAREFUL AT ALL TIMES!!

HELMETS STRONGLY RECOMMENDED for ADULTS

HELMETS REQUIRED FOR JUMPING and for JUNIOR RIDERS

 

EMERGENCY INFORMATION: Should you suffer an injury or illness, please list 3 persons to contact in order of preference, giving name, relationship and telephone number:

  1. _________________________________________________________________
  2. _________________________________________________________________
  3. _________________________________________________________________

Please list any allergies or medical conditions you have that might be relevant in case of an accident (such as sensitivity to bee stings, allergy to penicillin, prior back, head or knee injuries, etc.):

 

Please give any medical information that would need to be given to an emergency health care provider (insurance information such as Kaiser number, name and number of regular doctor if you have one, etc.):

 

MINORS MUST HAVE THE FOLLOWING SIGNED BY THEIR PARENT(S) OR LEGAL GUARDIAN:

We the undersigned parent(s) or legal guardian of ___________________ , a minor child, state that we have read the waiver, release and hold harmless agreement set forth above which shall apply to and be binding upon us and our minor child insofar as it pertains to her or his presence at the premises of American Canyon Training Center or participation in any activity relating to the handling or riding of any horse stabled or used at the premises of American Canyon Training Center and to any injury or damage or loss said minor child or her or his horse or equipment or other property may sustain or cause as a result of said presence or participation.

We further warrant and represent that we have health and accident insurance on said minor child.

We declare under penalty of perjury that the foregoing is true and correct.

EXECUTED THIS __ day of ________________, 20__ at _______________ County, California.

MOTHER:      __________________________________

FATHER:       __________________________________

Other:              __________________________________

                        __________________________________ [Relationship or title]