Liability Waiver 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.Client Name(Required) First Last Best Contact Email(Required) Enter Email Confirm Email Best Contact Phone(Required)I have read and fully understand the preceding agreement. I understand and accept that I am waiving liability against the above-mentioned parties.(Required) I agree. Date(Required) MM slash DD slash YYYY Signature(Required)Name(Required) First Last PhoneAddress(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you filling this out on behalf of a minor?(Required) Yes No Minor's InformationThe parent or legal guardian of any person less than 18 years of age must complete the following section. I, (Parent) hereby accept this waiver and release of liability on behalf of my minor child, (Student’s Name). 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/Guardian's Name(Required) First Last Student's Name(Required) First Last Parent/Guardian's Signature(Required)Parent/Guardian's Name(Required) First Last PhoneDate(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 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, , date of birth 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:Child's Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Name of Insurance Company(Required)Group Number & Member ID(Required)Primary Policy Number(Required)Parent/Guardian's Signature(Required)Parent/Guardian's Name(Required) First Last PhoneDate(Required) MM slash DD slash YYYY Δ
