Statesman Farm
Waiver & Release of Liability
I, _________________________, do hereby acknowledge that I am aware of, and fully understand all of the inherent risks involved in participating in/or viewing of equestrian pastimes. I understand that physical harm/or damage to my person or my property may result from the unpredictable nature of such large animals as horses. I hereby fully accept ALL responsibility for any and all damage occurring to my person, my property and my guests while on the premises of Statesman Farm. I hereby release and hold harmless the stable (Statesman Farm), its’ owners, volunteers, employees, affiliates, heirs and assigns from any and all claims arising from accident, injury or damage whatsoever which might occur during my involvement with the horses on said property AND on any property which stable owned horses and clients might be for other equine activities including, but not limited to, horse shows, rallies, trail rides, clinics and promotional events
Signed: __________________________________ Date: ____________________
Printed Name: ____________________________
PARENT OR LEGAL GUARDIAN MUST SIGN FOR ANY INDIVIDUAL UNDER THE AGE OF 18. PLEASE INDICATE MINOR’S NAME HERE:
______________________________________ DOB: _____________________
For NON Members of Statesman Farm, please provide the following:
Address: _________________________________________________________
Phone: __________________________
Email: ___________________________