Releash of Liability Form

THE DOVES GUIDANCE PROGRAM AT OXFORD RANCH
Hereinafter known as “This or The Ranch”
13749 E. Kettleman Lane
Lodi, Ca. 95240
Equine Riding Instruction and/or Training Instruction and/or Participation in Other Ranch Activities Agreement,
Liability Release and Assumption of Risk Agreement
READ CAREFULLY AND COMPLETE ALL SECTIONS BEFORE SIGNING
PLEASE FILL OUT ONE FORM PER INDIVIDUAL VISITING THE RANCH AND PLEASE PRINT CLEARLY
FIRST NAME: ___________________________ LAST NAME: ________________________________
Please check all that currently apply to
Emergency Contact Info
this PARTICIPANT:
First Name: ____________________ Last Name: ___________________
Phone #: (_______) ________________________
_ AGE 18 or older
Relationship to participant: _________________________________
_ Under AGE 18
Medical Insurance Info
My medical insurance company is ______________________________
My policy number is _________________________________________
_ Over 240 lbs.?
_ Under 10 hours riding experience?
_ Over 10 hours riding experience?
[ ] I do not carry medical insurance
Safety Questions
Does this participant have any physical or mental condition(s), which may affect his / her safety and ability to ride drive
and / or train a horse?
Yes No (Circle One)
If you circled “YES,” how can we help them with their special needs?
_________________________________________________________________________________________________
REGISTRATION OF PARTICIPANT AND AGREEMENT PURPOSE I, the above listed individual hereinafter known as the
"PARTICIPANT", and the parents or legal guardians there of if a minor, do hereby voluntarily agree to participate in all THE RANCH
activities; including horse riding, driving and handling as a student of THIS RANCH, and that if I ride a horse provided by THE RANCH,
I will do so for instruction purposes.
AGREEMENT SCOPE AND TERRITORY AND DEFINITIONS This agreement shall be legally binding upon me, the registered
PARTICIPANT, and the parents or legal guardians there of 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 THIS RANCH’S physical location. This agreement is
intended to be valid and binding at all times now and in the future when THIS RANCH permits me (directly or indirectly) to enter THIS RANCH’S
property, be on THIS RANCH’S property, be near any animal, receiving riding and/or training instruction or guidance from its associates and/or
when I ride and/or train and/or am near horses on or off of THIS RANCH’S property. Any disputes by the PARTICIPANT shall be litigated in, and
venue shall be the county in which THIS RANCH 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 term "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/WE ACKNOWLEDGE THAT: Risks, conditions, and dangers are inherent in meaning
an integral part of horse/equine/animal activities/ranch activities, regardless of all feasible safety measures which can be taken, and I
agree to assume them. The inherent risk 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 on or around the animals; the unpredictability of an animal’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 a
ranch 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 and a animal and/or failing to act within the ability of the participant.
Horses are 5-15 times larger, 20-40 times more powerful, and 3-4 times faster than a human. If a participant falls from horse to ground
it will generally be a distance of from 3.5 to 5.5 feet and the impact may result in harm to the participant. Horseback riding and equine
training are activities in which one much smaller, weaker predator (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
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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 an/or Running from danger. I also acknowledge that these are just some of the risk and I agree to
assume others not mentioned above. I am not relying on THIS RANCH to list all possible risks for me.
CONDITIONS OF NATURE WARNING, UNFAMILIAR AND SUDDEN SIGHTS, SOUNDS AND MOVEMENTS WARNING, AND
INSPECTION OF PREMISES I/WE AGREE THAT: This RANCH 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 EXAMPES ARE: Thunder, lightning, 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 understand
that these are just some of the risks and I agree to assume others mentioned not mentioned above. I am not relying on THIS RANCH to
list all possible conditions for me. The participant and parent or legal guardian have inspected THIS RANCH’S facilities and are
satisfied that all premise conditions are reasonably safe for this participant’s intended purpose, usage and presence upon THIS
RANCH’S premises.
SADDLE GIRTH/NATURAL LOOSENING I/WE ACKNOWLEDGE THAT: Saddle girths (fastener straps around horse's belly) may
loosen during riding. Participants must alert the instructor or attendant of any girth looseness so action can be taken to avoid slippage
of saddle and the potential for the participant to fall from the horse.
PROTECTIVE HEADGEAR / HELMET WARNING I / WE AGREE THAT: I for myself and on behalf of my child and / or legal ward
have been fully warned and advised by THIS RANCH 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 and / or driving and / or training 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
wearer’s head injuries and possibly prevent the wearer’s death from happening as the result of a fall and other occurrences. I am not
relying on THIS RANCH and / or its associates to provide a certified helmet for me or 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.
NO animals are to be brought onto THIS RANCH without prior authorization!
MEDICAL INSURANCE I / WE AGREE THAT: Should medical treatment be required, I and / or my medical insurance company
shall pay for ALL such incurred expenses.
PHOTO RELEASE I/WE RELEASE all rights to photos taken of me or the above mentioned for future use by The Doves Program, its
staff, founders, and/or Board of Directors in ranch publications, videos, books, newsletters, etc.
SAFETY AGREEMENT I/WE AGREE: to stay out of all barns, paddocks, corrals, tack-rooms, and all other non-office related buildings,
while waiting for horse related or other activities, or while waiting for a participant, unless given permission to be in those areas.
LIABILITY RELEASE I / WE AGREE THAT: In consideration of THIS RANCH allowing my
participation in this activity, under the terms set forth herein, I, the participant, 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 RANCH, its owners, Shannon and
Gayle Oxford, The DOVES Family & Youth Horsemanship Program, agents, employees,
volunteers, officers, directors, representatives, assigns, members, owners of premises and trails,
affiliated organizations, and insurers, and others acting on their behalf (herein after, 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 RANCH’S
and / or ITS ASSOCIATE’S ordinary negligence or legal liability; and I do further agree that except
in the event of THIS RANCH’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 RANCH 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 and operations of THIS RANCH, to include while riding,
driving, training, handling, or otherwise being near horses owned by me or owned by THIS
RANCH, or in the care, custody or control of THIS RANCH, whether on or off the premises of THIS
RANCH, but not limited to being on THIS RANCH’S premises.
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All Participants and/or Legal Guardians* must sign below after reading this entire document.
SIGNER STATEMENT OF AWARENESS
I / WE, THE UNDERSIGNED, REPRESENT THAT I/ WE HAVE READ AND DO UNDERSTAND THE FOREGOING
AGEEMENTS, LIABILILTYRELEASE AND ASSUMPTION OR RISK AGREEMENTS, I / WE UNDERSTAND THAT
BY SIGNING THIS DOCUMENT I AM GIVING UP RIGHTS TO SUE TODAY AND IN THE FUTURE. I / WE ATTEST
THAT ALL FACTS ARE TRUE AND ACCURATE. I AM SIGNING THIS WHILE OF SOUND MIND AND NOT
SUFFERING FROM SHOCK, OR UNDER THE INFLUENCE OF ALCOHOL, DRUGS OR INTOXICANTS.
__________________________________________________________________ ___________________
Signature of Participant (required for anyone 13 and over)
Date
__________________________________________________________________ ___________________
Signature of Legal Guardian* (required for anyone under 18)
Date
*Legal guardians do not include babysitters or friends of the family, unless that individual has been named guardian by a legal process,
Signed notes are not considered “legal.”
FAMILY CONTACT INFORMATION
•
PLEASE COMPLETE THIS SECTION JUST ONCE PER FAMILY IF ALL MEMBERS RESIDE AT THE SAME ADDRESS.
If members live at separate locations, please fill out ONE PER RESIDENCE. Thank You!
MAILING ADDRESS: _______________________________________________________
CITY: ___________________________ STATE: ______ ZIP: ______________
PHONE: (_______) ________-______________
EMAIL ADDRESS: ______________________________________
[ ] PLEASE DO NOT SEND US YOUR MONTHLY E-MAIL UPDATES.
[ ] PLEASE DO NOT SEND US YOUR QUARTERLY NEWSLETTER.
Family Members’ Name
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Date Of Birth
Adult
Youth
Req. for youth only
Please Ck
Please Ck