Name: Whistlejacket Farm’s Equestrian Weekend
Start: 2022-09-08T15:00:00-05:00
End: 2022-09-11T08:00:00-05:00
Location: Whistlejacket Farm

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Enter Email Confirm Email

Date of Birth(Required)

AHA Number

Dietary Restrictions

Horse(Required)

Yes

If Yes, what is your primary learning objective for you and or your horse?(Required)

What do I expect to get out of my weekend or day?(Required)

Choose Your Participation Option(Required)

Glamping Option 1 ($1250)

Auditor Option 2 ($150)

Glamping Accommodations

Accommodation Preference(Required)

Farmhouse (2-6 guests)

Casita (2 rooms available

Hotel in Alvarado (WF block rate booked directly with hotel)

*Accommodations and availability will be confirmed by phone. Someone from WF will contact you immediately upon receipt of your reservation to confirm availability of your lodging preference

*We will not run your credit card until we confirm your reservation and lodging accommodations by phone or email

WAIVER OF LIABILITY AND RELEASE

Warning: Under Texas law, an equine professional is not responsible for the injury to, or death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to Chapter 87 of the Civil Practice and Remedies Code.

I/We acknowledge the risks of horseback riding and related activities. In consideration of being permitted to take part in such activities at Whistlejacket Farm, LLC, or under the supervision of the Whistlejacket Farm, LLC employees. I/We, intending to be legally bound for myself, my heirs and assigns, executors or administrators, accept full responsibility for bodily injury, property damage, death, disability, medical, and other financial losses including, but not limited to time lost from work and or school.

I/We do hereby release and discharge the trainer, Wendy Griffith Potts, and operators, agents, officer, employees, and independent contractors from all actions, claims, demands, damages, costs, losses, and expenses that in any way arise from participation in equestrian activities, at or originating from Whistlejacket Farm, LLC. This includes any equestrian related activity conducted by Wendy Griffith Potts offsite including, but not limited to horse shows, lessons or training at other barns, and trail rides.

I/We understand that horseback riding is classified as a rugged adventure recreational sport activity and that there are inherent risks present despite safety precautions being taken.

I/We understand that it is not possible for any person or establishment to predict how a horse may react when frightened, angry, or under stress. It will react according to instinct and may run away, jump sideways/forward/or backward, kick with its hind legs, strike with its forelegs, buck, rear, bite, and/or throw its head upwards or sideways.

I/We understand that Whistlejacket farm, LLC and its staff are not responsible for acts or occurrences of nature, such as wind, water, thunder, lightning, irregular footing, or animals that can scare a horse or cause it to fall.

I/We understand that I/We can be held legally responsible for injuries or damage to Whistlejacket Farm, LLC, animals and/or property, and also for bodily injury, property damage, and/or death which I/We may cause by the failure to act in a prudent and cautious manner at all times.

I/We understand that wearing an ASTM approved helmet while mounting, riding, dismounting, and being around horses can protect against head injury. I/We understand that wearing protective headgear is our own responsibility.

I/We have current medical insurance and have provided the name of the insurance company on the following attachment.

I have read and fully understand the preceding agreement. I understand and accept that I am waiving liability against the above-mentioned parties.(Required)

Yes

Signature(Required)

Today's Date(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is this reservation for a minor or participant under the age of 18?(Required)

Yes

Participants Under the Age of 18

The parent or legal guardian of any person less than 18 years of age must complete the following section.

Parent/Legal Guardian Name(Required)

First Last

Student's Name(Required)

First Last

I, (Parent/Legal Guardian Listed Above) hereby accept this waiver and release of liability on behalf of my minor child, (Student’s Name Listed Above). I have read and fully understand the above agreement and the risks associated with this activity. I understand and accept that I am waiving liability against the above-mentioned parties.

Parent/Legal Guardian Signature(Required)

Today's Date(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Delegation of Authority to Consent to Emergency Medical Procedures

I/We consent to any emergency medical procedures necessary for my child in my absence. If I am unavailable for the purpose of obtaining my consent to emergency medical procedures, I delegate my authority to consent to treat for my child, (Student Name Listed Above), to Wendy Griffith Potts, Trainer and/or staff members of Whistlejacket Farm, LLC, 4025 S. Burleson Blvd, Alvarado, TX 76009.

I/We agree to pay all fees for physicians, hospitals, ambulances, and other medical charges responsibly and necessarily incurred. This release shall be in effect until the adult student, student’s parent, or guardians withdraw it in writing.

I/We understand that should medical emergency treatment be required, the information listed below will be provided to attending hospital or clinic to cover incurred bills. I/We carry current medical insurance with:

Name of Insurance Company(Required)

Group Number(Required)

Member ID(Required)

Primary Policy Holder(Required)

Parent/Legal Guardian Signature(Required)

Parent/Legal Guardian Name(Required)

First Last

Today's Date(Required)

Whistlejacket Farm’s Equestrian Weekend

September 8, 2022 @ 3:00 pm - September 11, 2022 @ 8:00 am

Glamping for Horse Lovers: Enjoy a Relaxing Weekend with Wendy Potts and Paul Kostial

Agenda – 2 Options to choose from:

Schedule of Activities

Lodging Options
First Come First Served!

Hotels in Alvarado:

Reserve Your Spot

Please complete the form below and we will call you directly to confirm availability, lodging details and process payment.

Glamping Accommodations

WAIVER OF LIABILITY AND RELEASE

Participants Under the Age of 18

Delegation of Authority to Consent to Emergency Medical Procedures

Details

Venue

Farm Address

Mailing Address

Whistlejacket Farm’s Equestrian Weekend

September 8, 2022 @ 3:00 pm - September 11, 2022 @ 8:00 am

Glamping for Horse Lovers: Enjoy a Relaxing Weekend with Wendy Potts and Paul Kostial

Agenda – 2 Options to choose from:

Schedule of Activities

Lodging Options First Come First Served!

Hotels in Alvarado:

Reserve Your Spot

Please complete the form below and we will call you directly to confirm availability, lodging details and process payment.

Glamping Accommodations

WAIVER OF LIABILITY AND RELEASE

Participants Under the Age of 18

Delegation of Authority to Consent to Emergency Medical Procedures

Details

Venue

Lodging Options
First Come First Served!