Painted Rose Ponies waiver form:
Please fill out, read and sign at the bottom.
Please return form at Party
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Today's Date:_________
Child's Name: _____________________________Parent/Guardian: _________________________
I, the undersigned hereby acknowledge that I have voluntarily registered my child in an activity of miniature horse riding.
I understand that the activities of miniature horse riding, and being around miniature horses involves numerous inherent risks of injury that are an integral part of such activities. Therefore, I assume full responsibility for all such risk, including loss of control, collisions, and obstacles whether they are obvious or not obvious. I and/or my family further understand that an equine irrespective of its training and usual past behavior and characteristics, may act or react unexpectedly or unpredictably at times, and I also assume such risks.
I understand that horses are unpredictable and that the risk of injury is inherent to the activity. I agree to assume all risk of injury or death caused by miniature horse riding, horse driving, or any related activities, whatever the cause, except as provided by law.
As consideration for being permitted to engage in the above activities at the residence of__________________. I do hereby waive any claim and release, _______________________, and Rick and Cindy Corven, instructors, owners, land owners, agents, or affiliated organizations from any and all injury or death caused by or resulting from my child’s participation in the above stated activities.
This contract shall be legally binding upon me, my heirs, my estate, assigns, legal guardians, and my personal representatives.
I have carefully read this agreement and fully understand the contents.
**THIS IS A RELEASE OF LIABILITY. DO NOT SIGN OR INITIAL THIS RELEASE IF YOU DO NOT UNDERSTAND OR DO NOT AGREE WITH ALL OF ITS TERMS.**
I give my permission for my child to ride, groom and feed a miniature horse at the residence of________________________, located at ____________________________________________.I Have Read and I Understand:
______I agree
Signature of Parent/Guardian__________________________________
Signature of Parent/Guardian__________________________________A protective helmet has been offered to wear while mounting, riding, and dismounting my horses. I have
accepted____________/ declined___________ the use of this helmet (initial appropriate response)
Please see attached: Arizona Revised Statutes 12-553 & Arizona Equine Warning Arizona
Equine Warning:
I/We Acknowledge that I/We have been informed of several inherent risks associated with equine activities ( meaning danger or condition that is an integral part of an equine activity), including, but not limited to any of the following
a) The propensity of an equine to behave in ways that may result in injury, death, or loss to persons on or around the equine.
b) The unpredictability of an equine’s reaction to sounds, sudden movement, unfamiliar objects, persons or other animals
c) Hazards, including, but not limited to surface or subsurface conditions.
d) A collision with another equine, another animal, a person, or an object.
e) The potential of an equine activity participant to act in a negligent manner that may contribute to injury, death, or loss to the person of the participant or to the other persons, including, but not limited to, failing to maintain control over an equine or failing to act within the ability of the participant.
Acknowledge that I/We are aware of the inherent risks of equine activities.
Affirm that I/We are willing and able to accept full responsibilities of my/our own safety and welfare.
Agree that I/We are releasing the equine owner or agent (or other affiliated with them) from liability unless the owner or agent is grossly negligent or commits willful, wanton, or intentional acts or omissions.
Arizona Revised Statutes: 12-553. Limited liability of equine owners and owners of equine facilities; exception; definitions
A. An equine owner or an agent of an equine owner who regardless of consideration allows another person to take control of an equine is not liable for an injury to or the death of the person if:
1. The person has taken control of the equine from the owner or agent when the injury or death occurs.
2. The person or the parent or legal guardian of the person if the person is under eighteen years of age has signed a release before taking control of the equine.
3. The owner or agent has properly installed suitable tack or equipment or the person has personally tacked the equine with tack the person owned, leased or borrowed. If the person has personally tacked the equine, the person assumes full responsibility for the suitability, installation and condition of the tack.
4. The owner or agent assigns the person to a suitable equine based on a reasonable interpretation of the person's representation of his skills, health and experience with and knowledge of equines.
B. Subsection A does not apply to an equine owner or agent of the equine owner who is grossly negligent or commits willful, wanton or intentional acts or omissions.
C. An owner, lesser or agent of any riding stable, rodeo ground, training or boarding stable or other private property that is used by a rider or handler of an equine with or without the owner's permission is not liable for injury to or death of the equine or the rider or handler.
D. Subsection C does not apply to an owner, lesser or agent of any riding stable, rodeo ground, training or boarding stable or other private property that is used by a rider or handler of an equine if either of the following applies:
1. The owner, lesser or agent knows or should know that a hazardous condition exists and the owner, lesser or agent fails to disclose the hazardous condition to a rider or handler of an equine.
2. The owner, lesser or agent is grossly negligent or commits willful, wanton or intentional acts or omissions.
E. As used in this section: 1. "Equine" means a horse, pony, mule, donkey or ass.
2. "Release" means a document that a person signs before taking control of an equine from the owner or owner's agent and that acknowledges that the person is aware of the inherent risks associated with equine activities, is willing and able to accept full responsibility for his own safety and welfare and releases the equine owner or agent from liability unless the equine owner or agent is grossly negligent or commits willful, wanton or intentional acts or omissions.
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