O'Hanlon Eventing Sept. 12 Clinic Entry Form
Please fill out the form completely. Email money transfers can be sent to BrittanyLMDurham@gmail.com with password "balsamhall"
Full Name *
If accompanying a rider please state their name below
Email *
Phone number *
OEF Number *
Name of Horse
Level *
Required
Dressage, Jumping, or Both? *
Required
Grooming Clinic: pick your topic ($45 per topic approx 1hr session, 1-3 participants per session)
WAIVER - I request permission to participate in this horseback riding competition at Balsam Hall. I fully understand that horseback riding, handling and grooming of horses and other stable and competition activities are very dangerous. I wish to participate in these activities knowing that they are dangerous. I accept and assume all the risks of injury (including death) to me or my property. In exchange for being permitted to participate in these activities, I release, for myself, my heirs, guardians, and legal representatives, and agree not to make or bring any claim of any kind against Balsam Hall, or officials, servants, volunteers, employees, representatives, officers, and directors for any injury (including death) to me or any damage to my property, arising out of my participation in these dangerous horseback riding or related activities. I acknowledge the contagious nature of the Coronavirus/COVID-19 and that public health authorities still recommend practicing social distancing. I further acknowledge that Balsam Hall has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.I further acknowledge that Balsam Hall can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other clients and their families.I voluntarily seek services provided by Balsam Hall and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending the clinic. I attest that:* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.* I have not traveled internationally within the last 14 days.* I have not traveled to a highly impacted area within Canada in the last 14 days.* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by local public health authorities.* I am following all health unit recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.I hereby release and agree to hold Balsam Hall harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the clinic, or that may otherwise arise in any way in connection with any services received from Balsam Hall I understand that this release discharges Balsam Hall from any liability or claim that I, my heirs, or any personal representatives may have against the barn with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Balsam Hall. This liability waiver and release extends to the barn together with all owners, partners, and employees. *
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