Equestrian "Add-On" Required Waiver for Camp Bethel
THANK YOU for choosing Equestrian as your "add on" at Camp Bethel in Fincastle, VA!
This is a participant release, waiver, and indemnification of liability form with Harmony Equestrian Center, LLC. You must read each part below before signing!
This waiver is sent IN ADDITION to your Confirmation Packet. Please review "Additional Items to Pack & Bring" and safety information here:
. This waiver must be completed and submitted at least 14 days before your first day of camp.
Our programs are open to everyone of all ages regardless of race, color, national origin, gender, and disability where accommodations can match needs.
COMPLETE THIS FORM THOROUGHLY. SCROLL DOWN AS YOU GO, and be sure to click the SUBMIT button at the bottom of the form! Items with a small red asterisk (*) are REQUIRED items.
Participant/Camper First & Last Name
Thank you for using correct capitalization for names and titles throughout this registration form.
Participant/Camper birth date
REQUIRED QUESTION: month / day / year; MM/DD/YYYY; example: 03/09/1999.
REQUIRED QUESTION: Number, Street or PO Box (and including apt #). Thank you for using correct capitalization.
REQUIRED QUESTION. Thank you for using correct capitalization.
State (2-letter postal abbreviation)
REQUIRED QUESTION. Please use the correct 2-letter postal abbreviation for your state.
REQUIRED QUESTION. zip code
Main phone/Cell phone of custodial Parent/Guardian
include area code, (ex: 540-555-1234)
Adult Authorization for Camper Participation:
I (YOUR CAMPER) do hereby acknowledge and agree in exchange for the good consideration of being permitted to engage in equine activities with Harmony Equestrian Center, LLC, a limited liability company, and Stacey Collins, Managing Member, that by engaging in an equine activity, I am participating in an activity that poses potentially serious risk of injury or death to myself and others. By signing this Release, Waiver and Indemnification of Liability, I assume the risk of all of the intrinsic dangers associated with participating in an equine activity pursuant to §§ 3.2-6200 through 3.2-6203 of the Code of Virginia, as amended. The intrinsic dangers associated with participation in equine activities are those dangers and conditions integral to participation in equine activities, including, but not limited to:
(1) the propensity of equines to behave in ways that may result in injury, harm, or death to persons on or around them;
(2) the unpredictability of an equine's reaction to such things as sound, sudden movement, and unfamiliar objects, persons, or other animals;
(3) certain hazards such as surface and subsurface conditions;
(4) collisions with animals or objects; and
(5) the potential of an equine activity participant acting in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the equine or not acting within the participant's ability. Va. Code § 3.2-6200 (1950, as amended).
Additionally, by singing this Release, Waiver and Indemnification of Liability, I waive and release any and all claims or rights to sue that I or my heirs may have in relation to my engagement in an equine activity, including injuries caused by negligence and those risks assumed above against Harmony Equestrian Center, LLC ("HEC"), Stacey Collins, any employees or volunteers of HEC, and any family members of the heretofore mentioned. It is my intent to give up those rights and hold the above parties harmless, and I do so knowingly and voluntarily. Further, I agree in consideration for and as a condition of my being allowed to participate in equine activities with HEC, to hereby indemnify, save, and hold harmless all of those parties heretofore mentioned, from any and all claims for loss, damage, and/or injury to myself, any third party, and/or any property resulting from, arising out of, during the course of, or in connection with my participation in said equine activity. By signing below, I acknowledge that I have read this Release, Waiver and Indemnification of Liability and understand the terms and conditions contained herein. This Release, Waiver and Indemnification of Liability is presumed effective until such time that written notice of revocation is provided by the participant (or the parent or guardian of participant if participant is a minor). The revocation shall be valid upon the date of receipt and is not applicable to times/dates prior to such receipt.
PARENT/GUARDIAN SIGNATURE OF PARTICIPANT who is UNDER 18 AT TIME OF REGISTRATION:
Electronic Signature of Parent or Guardian (type your full name)
Date of completion:
Today's date. REQUIRED QUESTION: month / day / year; MM/DD/YYYY; example: 05/09/2019.
PHOTO RELEASE: I authorize and consent to HEC using my image (i.e. photographs) and name for advertising and/or trade purposes.
By typing your initials below you agree to the Photo Release. If you do not, please type, "I do not agree to the photo release."
**To complete your waiver, (1) click Submit, and (2) print/save your "Additional Items to Pack & Bring".
If you do not click "Submit" we will not receive your waiver, so be sure to click SUBMIT. Thanks! Once submitted, you will be directed to a "Thank You" message with a link to the Additional Items to Pack & Bring page of our web site. Be sure to print/save your important Confirmation Packet/Additional Items to Pack & Bring.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service