Horse Riding Indemnity And Liability Release Form (Page 2 of 2) in pdf

Student Name:____________________________________ Email: _________________________________

Parent Name: ______________________________________ Contact Number:_________________________

8. HELMET WAIVER FOR VAULTING: Vaulting, a gymnastic sport, generally does not employ the use of

head gear for safety reasons. Helmets or head gear may become entangled in vaulting equipment,

impair balance and cause injury to you or other vaulters. You may still opt to wear one but you will be

limited to vaulting solo and only performing certain exercises. I have been offered the use of a safety

helmet but decline to use one while vaulting. ___________ (Initial here)

9. I HEREBY AUTHORIZE & CONSENT TO THE FOLLOWING MEDICAL TREATMENT FOR SAID MINOR(s): Any

x‐ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is

deemed advisable by, and is to be rendered under the general or special supervision of any physician

and/or surgeon licensed under the provisions of the Medical Practices Act, California Business and

Professions Code Section 2000 et seq.; or any x‐ray examination, anesthetic, dental or surgical diagnosis

or treatment, and hospital care to be rendered by a dentist licensed under the provisions of the Dental

Practices Act, California Business and Professions Code Section 1600 et seq. This authorization is given

pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain

effective until my child completes his/her activities in this program unless sooner revoked in writing. I

understand that as a parent/guardian, I will be responsible for the cost of any service or treatment

provided. _________________ (sign here)

10. LIABILITY RELEASE: I understand that, except in the event of OCVs’ 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 OCV. 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 I, or my child

or legal ward shall lose in employment or school or other activity. I hereby for myself, my heirs,

administrators and assigns release and discharge OCV (the instructor(s) and all of their officers and

employees from claims, demands, actions, and causes of action for such injuries sustained to my person,

or that of my child or legal ward and/or my property. __________ (Initial here)

11. INDEMNITY: I agree to indemnify and pay any expenses, loss or damage that is incurred by OCV and all

of their officers and employees arising out of my, my child or legal wards participation in any OCV

sponsored or related activity. _________ (Initial here)

12. 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

OCV 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 OCV

and all of their officers and employees for personal injuries suffered by said minor alleging negligent acts or acts

of omissions by OCV and all of their officers and employees. _______ (Initial here).

DO NOT SIGN BELOW UNLESS YOU HAVE THOROUGHLY READ AND UNDERSTOOD

THE ENTIRE CONTENTS OF THIS RELEASE FORM

______________________________ __________

________________________________ ____________

Signature of rider

Date

Signature of parent/Guardian

Date

________________________________________

_____________________________________________

Name of rider

Name of Parent/Guardian

*** PHOTO RELEASE: I hereby ____DO ____ DO NOT give my consent for the use of photos taken of me/my

child on OC Vaulting’s Facebook or webpage, newsletters, articles, etc. Such photos will be images only

(without identifying/names), unless express permission/consent is given, by initialing here ______.

Horse Riding Indemnity And Liability Release Form Page 2

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