Release of Liability

ACKNOWLEDGEMENT OF RISK
ACCEPTANCE OF RESPONSIBILITY & RELEASE OF LIABILITY

Print this form out. Read it in it's entirety. Fill in the blanks, sign and date at bottom. Please send one (1) release form per participant.

I, the undersigned, hereby acknowledge that I have voluntarily applied to engage in an activity of horseback riding with Barry Cox.

I understand that the activity of horseback riding involves numerous risks, including loss of control, collisions and obstacles, whether they are obvious or not obvious. I and/or my family further understand that an animal, 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 I may encounter variation in terrain, which may result in injury or damages. I acknowledge that these are my responsibility, and I assume the risk for these hazards, including breaks, growth, debris, rocks, cliffs and other hazardous surface or subsurface conditions and obstacles, whether they are obvious or not obvious, man made or natural.

I understand that animals 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 horseback riding, whatever the cause, except as provided by law.

As consideration for being permitted by Barry Cox to engage in the activity of horseback riding I do hereby waive any claim and release Barry Cox and all owners, officers, members, affiliated organizations, land owners, agents and or employees for any injury or death caused by or resulting from my participation in the activity of horseback riding.

This contract shall be legally binding upon my estate, assigns, legal guardians, my personal representatives, and me.

I have carefully read this agreement and fully understand the concerns. I am aware that I am releasing certain legal rights that I otherwise may have, and I enter into the contract in behalf of myself and/or my family of my own free will.

THIS IS A RELEASE OF LIABLITY. DO NOT SIGN OR INTIAL THIS RELEASE IF YOU DO NOT UNDERSTAND OR DO NOT AGREE WITH ITS TERMS.
Under 18 years of age, signature of parent or guardian is required

Your Full Name

__________________________________________________________

Attendees & ages
(list)

__________________________________________________________

Address

__________________________________________________________

City

__________________________________________________________

State
_____________________
Zip
_____________

E-mail Address

__________________________________________________________

Phone

__________________________________________________________

Fax

__________________________________________________________

Please Fill in the Work Shop name:

__________________________________________________________

Work Shop Date(s) you would like to attend:

__________________________________________________________

Amount Enclosed
$
________

comments:

__________________________________________________________

In case of emergency please notify
__________________________________
Phone
___________________

Emergency contact address
____________________________________
Alternate
Phone
_________________

Signature of participant
_________________________________________
Date
_____________

Signature of guardian
_________________________________________
Date
_____________

If this is for a minor child the parent/guardian must sign this form.

Questionnaire Please answer these questions to help us know a little more about you and your horse.

What do you expect to achieve from this work shop? ___________________________

______________________________________________________________________

Do you have any specific problems or things you would like to work on?

______________________________________________________________________

How would you describe your experience?
Beginner intermediate Advanced

Explain:________________________________________________________________

What is your horse's level of training?________________________________________

_______________________________________________________________________

Where did you hear about this workshop?____________________________________

Please mail form with check to:
Barry and Cheryl Cox
71031 Whiskey Creek - Wallowa, Oregon 97885

All checks should be made payable to Barry and Cheryl Cox.
For more information please call 541-886-5101

We look forward to working with you and your horse and hope you will be satisfied with your improvement when you complete the workshop.