Brushy Creek Ranch Cowboy Camps Registration 2021

Brushy Creek Ranch Cowboy Camps Registration 2021

1		2
Page 1		Page 2

Please select the date in which your child will attend
N/A
Child's Name
N/A

First Last
Age
N/A
Date of Birth
N/A
Gender
N/A
Grade
N/A
Experience with horses?
N/A
Experience with swimming?
N/A
Food Allergies
N/A
Parent/Guardian's Name
N/A

First Last
Address
N/A

Street Address
Address Line 2 City State/Region/Province
Postal / Zip Code

-Select-
Country
Email
N/A
Phone
N/A
Emergency Contact
N/A

First Last
Emergency Contact Phone Number
N/A
Medications to be sent with child?
N/A
If yes, please list below.
N/A

Horse Riding Indemnity and Liability Release Form
HORSEBACK RIDING CAN BE DANGEROUS
SERIOUS INJURY MAY RESULT FROM YOUR PARTICIPATION IN THIS ACTIVITY
1. HAZARDOUS ACTIVITY: I understand that horseback riding is a hazardous activity and that horses are unpredictable by nature; that when frightened or angry or under stress, a horse's natural instincts are to jump forward or sideways, to run away from danger at a trot, canter, or gallop, to kick, to buck, to rear up in front, or to bite; that horses are extremely powerful; and that if a rider falls to the ground, the fall distance will generally be more than 5 feet. I understand that these risks and voluntarily assume these risks and dangers for myself or on behalf of my child or legal ward.
Type Initials (I have read and understand the above statement)
N/A
Name
N/A

First Last
2. RIDING HELMETS: I understand that I can better protect myself against head injuries by wearing protective equestrian head gear while mounting, riding, dismounting and being around horses. Brushy Creek Ranch Services will provide helmets to all riders free of charge. I accept full responsibility for the increased risk of injury if I decide not to wear a helmet or not to require my child or legal ward to wear a helmet.
Type Initials (I have read and understand the above statement)
N/A
3. LIABILITY RELEASE: I understand that, except in the event of Brushy Creek Ranch Services wanton or willful negligence, I am responsible for bodily injury or property damage that I or my child or legal ward should sustain while riding a horse provided by Brushy Creek Ranch Services. I am also responsible for medical expenses or any other expense incurred as a result of such bodily injury or property damage. I am responsible for any time l. or my child or legal ward shall lose in employment or school or other activity. I hereby for myself, my heirs, administrators or assigns release and discharge Brushy Creek Ranch Services (the trail ride operators) and all of their officers and employees from claims, demand, actions, and causes of action for such injuries sustained to my person, or that of my child or legal ward and/or my property.
Type Initials (I have read and understand the above statement)
N/A
Date
N/A

dd-MMM-yyyy
4. INDEMNITY: I agree to indemnify and pay any expenses, loss or damage that is incurred by Brushy Creek Ranch and all their officers and employees arising out of my rental and riding, or my child or legal ward's rental and riding of a horse supplied by Brushy Creek Ranch Services.
Type Initials (I have read and understand the above statement)
N/A
5. INDEMNITY / LIABILITY RELEASE BY PARENT OR GUARDIAN OF MINOR CHILD OR LEGAL WARD: in the knowledge that a parent by law cannot waive the personal injury rights or other claims of a (their) minor child or legal ward, the undersigned parent or guardian of said minor child or legal ward agrees to indemnify Brushy Creek Ranch Services and all of their officers and employees from any financial loss suffered as a result of any claim brought on behalf of said minor child or legal ward. Further, I agree not to bring any claim or other legal action against Brushy Creek Ranch Services all of their officers and employees for personal injury Brushy Creek Ranchs suffered by said minor alleging negligent acts or acts of omissions by Brushy Creek Ranch Services and all their officers and employees.
Type Initials (I have read and understand the above statement)
N/A
DO NOT SIGN BELOW UNLESS YOU HAVE THOROUGHLY READ AND UNDERSTOOD THE ENTIRE CONTENTS OF THIS RELEASE FORM
Name of Rider
N/A

First Last
Signature of Rider
N/A
Date
N/A

dd-MMM-yyyy
Email
N/A
Verification Code *
Enter the text in the box below

Brushy Creek Ranch Cowboy Camps Registration 2021

Error Occurred

Link to resume this form later:

Turn on the camera permission in your browser to continue further