Liability Waiver

Sharing our love of horses & the outdoors for almost 25 years!

540-886-7768

PARTICIPANT CONTACT INFORMATION

Participant's Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Email

Contact Phone

Emergency Contact Name

Emergency Contact Phone

Relationship to Participant

PERSONAL/MEDICAL HISTORY

DOES PARTICIPANT HAVE ANY PHYSICAL OR MENTAL CONDITION(S) that may affect his/her safety and ability to ride a horse?

If “Yes,” how can we help this participant with his or her special needs?

Age

Participant's Date of Birth

WEIGHT OVER 230LBS:

HORSE RIDING EXPERIENCE (Check one that applies)

Beginner (under 10 hours)
Over 10 Hours

MEDICAL INSURANCE I/WE AGREE THAT

YES, I AGREE & UNDERSTAND Should medical treatment be required. I and/or my/ medical insurance shall pay for ALL such incurred expenses.

Insurance Company

I do not carry medical insurance

No Insurance

RIDING VOLUNTARILY

YES, I AGREE & UNDERSTAND I, the above listed individual and the parents or legal guardian thereof if a minor, (Participant) hereby acknowledge that I have voluntarily applied and contracted to participate in the sport or activity of horse riding/camping from a primitive camp, with equipment and/or services to be provided by NORTH MOUNTAIN OUTFITTER, INC. (OUTFITTER) By my initials hereon and at each place hereafter marked, I have signified my agreement with and acceptance of the terms, statements and conditions herein.

RISKS, DEFINITIONS, & WARNINGS

AGREEMENT SCOPE AND TERRITORY AND DEFINITIONS

YES, I AGREE & UNDERSTAND This agreement shall be legally binding upon registered participant. and the parents or legal guardians thereof if a minor, my heirs, estate, assigns, including all minor children and personal representatives: and it shall be interpreted according to the laws of the state and county of the THIS STABLE’S physical location. This agreement is intended to be valid and binding at all times now and in the future when THIS STABLE permits me (directly or indirectly) to enter THIS STABLE'S property, be on THIS STABLE'S property, be near any horse, receive instruction or guidance from its associates and/ or when I ride and/or am near horses on or off of THIS STABLE'S property. Any disputes by the participant shall be litigated in, and venue shall be In the county in which THIS STABLE is physically located. This agreement is intended to be as broad and inclusive as the law permits. If any clause, phrase, or word is in conflict with state law, then that single part is null and void. The terms “HORSE” and “EQUINE” herein shall refer to all equine species: The terms “I”, “WE”, “ME”, “MY” shall herein refer to the above registered participant and the parents or legal guardians thereof if a minor.

INHERENT RISKS/ASSUMPTION OF RISKS I ACKNOWLEDGE THAT

YES, I AGREE & UNDERSTAND Horseback riding is classified as a RUGGED ADVENTURE RECREATIONS ACTIVITY and that risks, conditions, and dangers are inherent in (meaning an integral part of) horse/equine/animal activities, regardless of all feasible safety measures which can be taken, and l agree to assume them. The inherent risks include, but are not limited to any of the following: The propensity of an animal to behave in ways that may result in injury, harm, death, or loss to persons or around the animal; The unpredictability of an equine’s reaction to sounds, sudden movement, unfamiliar objects, persons or other animals; Hazards, including, but not limited to, surface or subsurface conditions. A collision, encounter and or confrontation with another equine, another animal, a person, or an object. The potential of an equine activity participant to act in a negligent manner that may contribute to injury, harm, death, or loss to the participant or to other persons, including but not limited to, failing to maintain control over an equine and/or failing to act within the ability of the participant Horses are 5 to 15 times larger, 20 to 40 times more powerful, and 3 to 4 times faster than a human. If a rider falls from horse to ground it will generally be at a distance from 3 ½ to 5 ½ feet, and the impact may result in harm to the rider. Horseback riding is an activity in which one much smaller, weaker predator animal (the human) tries to impose its will on and become one unit of movement with another much larger stronger prey animal that has a mind of its own (the horse) and each has a limited understanding of the other. If a horse is frightened or provoked it may divert from its training and act according to its natural survival Instincts which may include but are not limited to, stopping short, spinning around changing directions and/or speed at will; shifting its weight, bucking, rearing, kicking, biting and/or running from danger. I also acknowledge that these are just some of the risks and I agree to assume others not mentioned above, I am not relying on THlS STABLE to list all possible risks for me.

WILDERNESS EXPERIENCE PARTICIPATION, CONDITIONS OF NATURE WARNING, UNFAMILIAR AND SUDDEN SIGHTS, SOUNDS, AND MOVEMENTS WARNING, AND INSPECTION OF PREMISES. I/WE ACKNOWLEDGE THAT

YES, I AGREE & UNDERSTAND The participant may be taking part in a “WILDERNESS EXPERIENCE” that may be hazardous to people. I/WE ACKNOWLEDGE THAT the meaning of “WILDERNESS EXPERIENCE” ls defined as the pursuit of activity in a natural and/or wild and/or rugged and/or uncultivated area or region as of forest and/or hills and/ or mountains and/or plains and/or wetlands which would likely be uninhabited by people and inhabited by wild animals of many types and species to include, but not limited: mammals, reptiles, and insects which are not tame, may be savage and unpredictable in nature and also wandering at their will. I/WE ACKNOWLEDGE THAT: THIS STABLE is NOT responsible for total or partial acts occurrences or elements of nature and/or sudden and/or unfamiliar sights, sounds and/or sudden movements that can scare a horse cause it to fall or react in some other unsafe way. SOME EXAMPLES ARE: Thunder, lightening, rain, wind, wild and domestic animals, insects, reptiles, which may walk, run or fly near, or bite or sting a horse or person and irregular footing on out-of-door groomed or wild land which is subject to constant change in condition according to weather, temperature and natural and man-made changes in landscape. I also acknowledge that these are just some of the risks and I agree to assume other not mentioned above. I am not relying on THIS STABLE to list all possible conditions for me. The participant and parent or legal guardian have inspected THIS STABLE'S facilities and are satisfied that all premise conditions are reasonably safe for this participant's intended purpose, usage and presence upon THIS STABLE'S premises.

CARRY-ON OBJECTS WARNING AND SHARP, LOUD NOISES WARNING I/WE ACKNOWLEDGE THAT

YES, I AGREE & UNDERSTAND When approaching, mounting and riding horses I must not carry loose items that may fall or blow away or flap in the wind or bounce or make sharp or loud noises, the action of which may scare horses causing them to react in unsafe ways. SOME EXAMPLES ARE: cell phones, hats not securely fastened under chin, toys, and purses. When near or riding a horse participants must not make sharp or loud noises, such as whistling or screaming or yelling, the sound of which may scare horses causing them to react in unsafe ways.

SADDLE GIRTH LOOSENING WARNING I/WE ACKNOWLEDGE THAT

YES, I AGREE & UNDERSTAND Saddle girths (fastener straps around the horse's belly) may loosen during riding. Riders must alert the nearest attendant of any girth looseness so action can be taken to avoid saddle slippage and the potential for the rider to fall from the horse.

RIDER AGE/PROTECTIVE HEADGEAR/HELMET REQUIREMENT

RIDERS 18 & YOUNGER: Must wear the protective headgear/helmet.
RIDERS 18 & OLDER: Must choose to wear or not to wear the protective headgear/helmet by checking the acceptance or refusal that follows.

PROTECTIVE HEADGEAR/HELMET WARNING AND OFFERING: I/WE AGREE THAT

YES, I AGREE & UNDERSTAND I for myself and on behalf of my child and/or legal ward have been fully warned and advised by THIS STABLE that protective headgear/helmet which meets or exceeds the quality standards of the SEI CERTIFIED ASTM STANDARD F 1163 Equestrian Helmet, should be worn while riding, handling and/or being near horses and I understand that the wearing of such headgear/ helmet at these times may reduce severity of some of the wearers head injuries and possibly prevent the wearer's death from happening as the result of a fall and other occurrences. I/WE ACKNOWLEDGE THAT: THIS STABLE has offered me and my child and/or legal ward if applicable protective headgear/helmet that meets or exceeds the quality standards of the SEI CERTIFIED ASTM STANDARD F 1163 Equestrian Helmet I/WE ACKNOWLEDGE THAT: Once provided if I choose to wear the protective headgear/helmet offered that I/WE will be responsible for properly securing the headgear/helmet on the participant's head at all times. I am not relying on THIS STABLE and/or its associates to check any headgear/helmet or headgear/helmet strap that I may wear or to monitor my compliance with this. suggestion at any time now or in the future.

PROTECTIVE HEADGEAR/HELMET ACCEPTANCE OR REFUSAL SELECTION FOR RIDERS 16 YEARS AND OLDER

PROTECTIVE HEADGEAR/HELMET ACCEPTANCE I/WE request for this participant to wear protective headgear/helmet which THIS STABLE provides and I/WE will be solely responsible for securing the headgear/helmet on the participant’s head.
PROTECTIVE HEADGEAR/HELMET REFUSAL: I/WE refuse this participant to wear any type of protective headgear/helmet and/or will provide MY/OUR own. l/WE assume full responsibility for MY/OUR safety in this decision.

LIABILITY RELEASE

Participant's RISKS/ASSUMPTION his/her

LIABILITY RELEASE I AGREE THAT

YES, I AGREE & UNDERSTAND In consideration of THIS STABLE allowing my participation in this activity under the terms set forth herein, I for myself and on behalf of my child and/or legal ward, heirs, administrators, personal representatives or assigns, do agree to release, hold harmless, and discharge THIS STABLE, its owners, agents, Page of 2 3employees, officers, directors, representatives, assigns, members, owners of premises and trails affiliated organizations and insurers and others acting on their behalf (hereinafter, collectively referred to as “Associates”), of and from all claims, demands, causes of action and legal liability, whether the same be known or unknown, anticipated or unanticipated, due to THIS STABLE'S and/or ITS ASSOCIATES ordinary negligence or legal liability and I do further agree that except in the event of THIS STABLE'S gross negligence and/or willful and/or wanton misconduct, I shall not bring any claims, demands, legal actions and causes of action, against THIS STABLE and ITS ASSOCIATES as stated above in this clause for any economic and non-economic losses due to bodily injury and/or death and/or property damage, sustained by me and/or my minor child or legal ward in relation to the premises an and operations of THIS STABLE, to include while riding, handling, or otherwise being near horses owned by me or owned by THIS STABLE or in the care, custody or control of THIS STABLE, whether on or off the premises of THIS STABLE, but not limited to being on THIS STABLE'S premises.

VIRGINIA WARNING

YES, I AGREE & UNDERSTAND §3.1-796.132. Liability limited; Liability actions: prohibited. A. Except as provided in § 3.1-796.133, an equine activity sponsor, an equine professional, or any other person, which shall include a corporation, partnership, or limited liability company shall not be liable for an injury to or death of a participant resulting from the intrinsic dangers of equine activities and, except as provided in § 3.1-796.133, no. participant nor any participant's parent, guardian, or representative shall have or make any claim against or recover from any equine activity sponsor, equine professional, or any other person for injury, loss, damage, or death of the participant resulting from any of the intrinsic dangers of equine activities. B. Except as provided in § 3.1-796.133, no participant or parent or guardian of a participant who has knowingly executed a waiver of his rights to sue or agrees to assume all risks specifically enumerated under this subsection may maintain an action against or recover from an equine activity sponsor or an equine professional for an injury to or the death of a participant engaged in an equine activity. The waiver shall give notice to the participant of the intrinsic dangers of equine activities. The waiver shall remain valid unless express!y revoked in writing by the participant or parent or guardian of a minor.

SIGNER STATEMENT OF AWARENESS

Each participant and parent or legal guardians must sign below after reading and completing this entire document.

SIGNER STATEMENT OF AWARENESS

YES, I AGREE & UNDERSTAND I/WE, THE UNDERSIGNED, REPRESENT THAT I/WE HAVE READ AND-DO UNDERSTAND THE FOREGOING AGREEMENT, LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT. I/WE UNDERSTAND THAT BY SIGNING THIS DOCUMENT I/WE AM GIVING UP RIGHTS TO SUE TODAY AND IN THE FUTURE. I/WE ATTEST THAT ALL FACTS ARE TRUE AND ACCURAlE. I AM SIGNING THIS WHILE OF SOUND MIND AND NOT SUFFERING FROM SHOCK OR UNDER THE INFLUENCE OF ALCOHOL, DRUGS, OR INTOXICANTS.

THIS CONTRACT/AGREEMENT

YES, I AGREE & UNDERSTAND although electronic, this contract shall be legally binding upon clients, client’s heirs, client's estate, assigns, legal guardians, and client’s personal representatives.

Signature of Participant

Clear Signature

Date

Contact Us

North Mountain Outfitter
709 North Mountain Road
Swoope, Virginia 24479
540.886.7768

North Mountain Outfitter is a permittee
of the George Washington National Forest

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