Liability Release Form printable pdf download

RIDER agrees that by performing the act of riding on the premises of the

Liability Release Form

OWNER or under the direction of the OWNER or their representatives, trainers,

teachers, agents or assigns, RIDER indicates understanding and acceptance of

This RELEASE OF LIABILITY (RELEASE) is made and entered into this _________

the terms and conditions of this entire RELEASE without exception.

day of ______________, 20_____ for the benefit of Scott Book and Forrest Book III,

This RELEASE is non-assignable and non-transferable and is made and entered

d/b/a Book Family Farm: hereinafter referred to as OWNER with an address of 251and

into in the COMMONWEALTH OF PENNSYLVANIA, and shall be enforced

244 S. Sandy Hill Rd, Coatesville PA 19320, as well as Locust Lane Riding Center, LLC,

and interpreted under the laws of this Commonwealth.

with an address of 375 Coffroath Road, Coatesville, PA 19320, the staff, agents,

IMPORTANT NOTICE: This is a legally binding document and you have the

volunteers, owners of the land of both establishments, by _______________________and

right to review it with legal counsel prior to signing it.

if RIDER is a minor, RIDER’S parents or legal guardian

________________________________________, hereinafter referred to as RIDER.

10. Intending to be legally bound, RIDER signs this RELEASE OF LIABILITY.

In consideration for the use of today and for all future dates of animals, property, facilities,

equipment, and services of OWNER at the farm known as Book Family Farm, the

RIDER or / RIDER’S PARENT OR LEGAL GUARDIAN

OWNER of Book Family Farm, LLRC, landowner and RIDER, their heirs, successors,

assigns, and legal representatives intending to be legally bound, herby expressly agree to

Consent for you or your child’s picture to be used for publicity purposes:

the following:

Circle one yes no

Recognizing and accepting that horseback riding can be a dangerous activity,

(According to National Electronic Injury Surveillance Systems of United States

Consumer Products, horse activities ranked 64

among the activities of people

RIDER or / RIDER’S PARENT OR LEGAL GUARDIAN

relative to injuries that result in a stay in the hospital.) and it is the responsibility

of the RIDER to carry full and complete insurance coverage for his/her personal

Consent to Emergency Medical, Dental, Surgical Treatment for

property, and himself/herself.

Recognizing and accepting the pursuit of an adventure type activity in a wild,

Minor Child

rugged, and 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

My name is________________________________________________________. I am

people and inhabited by wild animals of many types and species to include, but

not limited to mammals, reptiles, and insects, which are not tame, may be

the (Mother / Father / Guardian) of ________________________________, a minor child

savage and unpredictable in nature and also wandering at their will.

and riding student of Locust Lane Riding Center, LLC or The Book Family Farm. I

RIDER agrees to assume ANY AND ALL RISKS RELATED TO OR

hereby consent to any medical, dental, surgical treatment or procedure of an emergency

ARISING FROM RIDER’S USE OF OR PRESENCE UPON OWNER’S

nature that is reasonably necessary to save the life of the minor child named above, or to

PROPERTY AND FACILITIES including but not limited to, the risk of death,

restore the child to health.

bodily injury, permanent disability, falls, kicks, or bites.

RIDER agrees to hold OWNER and all of their successors, assigns, affiliates,

Name of insurance company_______________________ Policy Number______________

officers, directors, employees, and agents completely harmless and not liable

and release them from all liability whatsoever on account of or in connection

I understand that should medical emergency treatment be required, the current insurance

with any claims, causes of action, injury, damages costs, attorney’s fees or

information here will be provided to the attending clinic or hospital to cover future

expenses arising out of RIDER’S use of or presence upon OWNERS property

payment of incurred bills.

and facilities, including without limitation, those based on death, bodily injury,

property damage, including inconsequential damages.

Contact Numbers: Home_____________________ Cell_________________________

RIDER agrees to waive the protection awarded by any statue or law in any

Emergency Numbers: Home_____________________ Cell_______________________

jurisdiction whose purpose and/or effect is to provide that a general release shall

Person to contact:_________________________________________________________

not extend to claims, material or otherwise, which the person giving the release

does not know or suspect to exist at the time of executing this Release.

Please list any allergies or medical conditions attending clinic or hospital may need to be

RIDER agrees to indemnify OWNER against and hold them harmless from any

aware of.

and all claims, causes of action, damages, judgments, cost or expenses,

including payment of attorney’s fees, which in any way arise from RIDER’S use

of or presence upon OWNER’S property or facilities.

251 S> Sandy Hill Rd. Coatesville, PA 19320 Phone: 610-283-3173 Email:

Liability Release Form

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