Waiver's and Forms

 

 

 

                       

ROCKIN' P TRAIL RIDING WAIVER  

This form needs to be filled out by ALL RIDERS. For anyone who wishes to ride at the Rockin' P Ranch please print and completely fill out this form. Any rider who is under the age of 18 MUST have a Parent or Legal Guardian sign this Liability Waiver Form.

CLICK HERE FOR THE: Trail Rider Liability Form

HAVING TROUBLES? Copy and Paste into a new document.

RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK

AND INDEMNITY AGREEMENT

 

PLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING!

 Express Assumption of Risk Associated with, but not limited to, Trail Rides, Pony Leads, Camp, Clinics,

Horse Care Overviews, and Lessons – hereby known as “ACTIVITY” and/or “ACTIVITIES”:

 ADULT(S) - PLEASE PRINT NAME or NAMES (only if RELATED):

(#1)_______________________________________________________and (#2) ________________________________________________,

hereby known as “UNDERSIGNED”, do hereby affirm and acknowledge that I/We have been fully informed of the inherent hazards and risks associated with “ACTIVITIES” in which I/We or the minor(s) for which I/We claim full responsibility.

  “ACTIVITY” and/or “ACTIVITIES” Inherent hazards and risks include but are not limited to:

1.  Risk of injury from the “ACTIVITY” and equipment utilized in an “ACTIVITY” is significant including the potential for permanent disability and even death.

2.  Possibility equipment failure and/or malfunction of my/our own or other’s equipment.

3.  My/Our own negligence and/or the negligence of all others, including but not limited to, owners, officers, employees, agents, independent contractors, volunteers, clients or any representative of the Rockin’ P Public Riding Ranch, Inc. and the Pekin Park District, including but not limited to operator error.

4.  The propensity of any type of horse, mule, donkey, hereby known as equine, to behave in dangerous ways that may result in injury,  regardless of the equine’s previous training and past performance.

5.  The inability to predict an equine’s reaction to sound, movements, unfamiliar environment, objects, persons, or animals.

6.  Natural hazards including but not limited to surface or subsurface conditions.

7.  Propensity for an equine to run, buck, bite, kick, shy, stumble, rear, trample, scratch, peck, fall, make unpredictable movements, spook, go down, jump, butt, step on person’s feet, push or shove without warning or apparent cause.

8.  Saddles or bridles that loosen or break which may cause the participant to be jolted or fall.

9.  The equine may also react in a dangerous manner when a condition or treatment is considered hazardous.

10.  The potential for any participant to fail to exercise reasonable care, take adequate precautions, or use adequate control when engaging in an animal “ACTIVITY”, including failing to maintain reasonable control of the equine or failing to act in a manner consistent with the person’s abilities.

11.  Collisions with trees, brush, and other animals or objects.

12.  Broken bones, severe injuries to the head, neck and back which may result in severe impairment or even death.

13.  Cold weather and heat related injuries and illness, including but not limited to frostnip, frost bite, heat exhaustion, heat stroke, sunburn, hypothermia and dehydration.

14.  Exposure to outdoor elements, including but not limited to rock fall, inclement weather, thunder and lighting, severe and/or varied wind, temperature and all other weather conditions.

15.  Attack by or encounter with insects, reptiles, deer and/or other animals.

16.  Accidents or illness occurring in remote places where there is no or delayed medical response or facilities.

17.  Fatigue, chill, and/or dizziness, which may diminish reaction time and increase the risk of accident.

18.  Sense of balance, physical coordination, and ability to follow instructions. 

 I/We understand these risk descriptions are not complete and unknown or unanticipated risk may result in injury, illness or death.

 I/We declare myself/ourself and/or the minor(s) for which I/We claim full responsibility, do not and have not suffered from any form of mental or physical medical conditions which I/We understand may lead to a dangerous situation with regards to other persons or myself/ourself during “ACTIVITIES”.   I/We also understand that no one is permitted to ride a horse, pony, mule if pregnant.

 In consideration for being permitted to participate in any way in “ACTIVITIES”, I hereby agree, acknowledge and appreciate that:

1.  I/We, the “UNDERSIGNED”, HEREBY RELEASE AND HOLD HARMLESS THE ROCKIN’ P PUBLIC RIDING RANCH AND PEKIN PARK DISTRICT including, but not limited to, their owners, officers, employees, agents, independent contractors, volunteers, clients or any other representative - hereby known as “RELEASEES”, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss of damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE.

2.  I/We, the “UNDERSIGNED”, release the “RELEASEES” from liability and responsibility whatsoever and for any claims or causes of action that my/our estate, heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the “ACTIVITIES” whether caused by active or passive negligence of the “RELEASEES” or otherwise.  By executing this document, I/We agree to hold the “RELEASEES” harmless and indemnify them in conjunctions with any injury, disability, death, or loss or damage to person or property that may occur as a result of engaging in “ACTIVITIES”.

3. By entering into this Agreement, I/We, the “UNDERSIGNED”, I/We are not relying on any oral or written representation of statements made by “RELEASEES”, other than what is set forth in this Agreement.

 This release shall be binding to the fullest extent permitted by law.  If any provisions of this release are found to be unenforceable, the remaining terms shall be enforceable.

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 I/We, the “UNDERSIGNED”, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND I/We FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I/We HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT AND I/We SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

 X Print Name and Sign: _____________________________________________________________________________   Date___________

                                                           “UNDERSIGNED” Adult #1

 X Print Name and Sign: _____________________________________________________________________________   Date___________

                                                           “UNDERSIGNED” Adult #2

 FOR MINOR PARTICIPANTS - Under Age 18: This is to certify that I, the “UNDERSIGNED”, as Parent, Guardian, Temporary Guardian with legal responsibility for this participant(s), do consent and agree not only to his/her release of all “RELEASEES”, but also to release and indemnify “RELEASEES” from any and all liabilities incident to his/her involvement in these “ACTIVITIES” for myself, my heirs, assigns, and next of kin.

 Minor(s) Full Names(s) ______________________________________________________________________________________________

                       _______________________________________________________________

 X Print Name and Sign: _____________________________________________________________________________ Date____________

                                                            “UNDERSIGNED” Parent/ Legal Guardian

 This release shall be binding to the fullest extent permitted by law.  If any provisions of this release are found to be unenforceable, the remaining terms shall be enforceable.

 PROTECTIVE HEADGEAR REFUSAL

ANYONE UNDER AGE 16 MUST WEAR A HELMET

I/We, the “UNDERSIGNED”, for myself/ourself and/or on behalf of my/our child or Legal Ward, have been fully warned and advised by Rockin’ P Public Riding Ranch, Inc. that we should wear a properly fitted helmet in order to reduce some or all of our head injuries as the result of a fall or any other occurrence associated with this Hazardous “ACTIVITY”.   I/We realize that we are subject to injury from this “ACTIVITY” to which we are exposing ourselves purely voluntarily.  I/We, the “UNDERSIGNED”, also agree to release and indemnify the “RELEASEES” from any and all liabilities incident to my involvement in these “ACTIVITIES” for myself/oursefl, my/our heirs, assigns and next of kin.

 AGAINST THIS ADVICE, I/WE ARE REFUSING THIS CRITICAL SAFETY PRECAUTION.

            

I/We, the “UNDERSIGNED”, have read this foregoing statement and do understand its warnings and assumption of risks.

 X Print Name and Sign:________________________________________________________________________________Date_________

                                                            “UNDERSIGNED” ADULT #1

 X Print Name and Sign:________________________________________________________________________________Date_________

                                                            “UNDERSIGNED” ADULT #2

 FOR MINOR PARTICIPANTS -Ages of 16 or 17 (ALL other Minors MUST wear a Helmet): This is to certify that I, the “UNDERSIGNED”, as Parent, Guardian, Temporary Guardian with legal responsibility for this Minor, do consent and agree not only to his/her release of “RELEASEES”, but also to release and indemnify the RELEASEES from any and all liabilities incident to his/her involvement in these “ACTIVITIES” for myself, my heirs, assigns and next of kin.

MINORS(s) full name(s) _____________________________________________________________________________________________

                            ______________________________________________________________

                        Print Name and Sign: _________________________________________________________________________________Date___________

                                             “UNDERSIGNED” Parent/ Legal Guardian of Minor(s) listed above

 This release shall be binding to the fullest extent permitted by law.  If any provisions of this release are found to be unenforceable, the remaining terms shall be enforceable.

 WARNING:  Following is the Illinois Equine Activity Act 745 I.L.C.S. 47/1:

Under the Illinois Equine Activity Act, each participant who engages in an equine activity expressly assumes the risk of engaging in and is legal responsibility for injury, loss, or damage to person or property resulting in the risk of equine activities.

 

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Please, ALWAYS initial and sign where indicated by a red arrow.  If signing for a minor also fill out the yellow highlighted area.

 

 

 

 BRINGING IN YOUR OWN HORSE? 

Planning on hauling in your own horse for the day? Please print and fill out this form prior to arrival. April-October, Friday-Sunday, Weather permitting only. All horses require a negative coggins and a $10 fee. Trailer in horses will not be permitted to ride with our line horses.

 Trailer-In Liability Form

Volunter Liability Form

 

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