Bucklebury Horse Camp Waiver, Agreement and Liability Release

Read Carefully Before Signing.

 

 

I agree to the following agreement as a condition for the persons identified as “Child” below, to do any or all of the following: be near horses or ponies (hereafter referred to as “equines”); ride, work with, work around, or handle equines; participate in equine related lessons; receive instruction or guidance in riding, handling or working with equines  and/or attend clinics, day camps, schooling shows, or special events. (All of these activities, individually and collectively, will hereafter be referred to as “Activities”.)

 

 

Name of Contracting Party (Parent or Guardian):

 

___________________________________________________________________

 

Name of Other Contracting Party (Spouse or Other Guardian):

 

___________________________________________________________________

 

Addresses of Contracting Parties:

 

___________________________________________________________________

 

___________________________________________________________________

 

Phone:             [Home] _____________________        

[Work] _____________________

[Cell/Other] _________________

 

 

 

I also make this agreement on behalf of the following, who is/are my children or legal ward(s):

 

Child’s Name:  ____________________________  Child’s Date of Birth _________

Child's Experience Level (0-3) _______ Desired Week of Registration____________

 

Additional Child:  ____________________________  Child’s Date of Birth _________

Child's Experience Level (0-3) _______ Desired Week of Registration____________

 

Additional Child:  ____________________________  Child’s Date of Birth _________

Child's Experience Level (0-3) _______ Desired Week of Registration____________

All

 

All parts of this agreement shall apply to me, and the children/legal wards listed above. [We will collectively call ourselves “I”, “me” or “my” throughout this agreement.] This Waiver, Agreement and Liability Release is intended to be valid and binding at all times, now and in the future, when Emily Jenkins, or any Bucklebury Horse Camp counselor, affiliate, employee or volunteer, permits me (directly or indirectly) to engage in any or all of The Activities described above at any time and at any location.

 

 

 

                  IT IS HEREBY AGREED AS FOLLOWS:

 

1.                     I have requested to engage in any or all of The Activities.

 

2.                     Risks. I understand that anyone riding, handling, working with, or even near an equine can suffer bodily and other injuries. Among other things, equines are unpredictable by nature. For example, when frightened, angry, or under stress, the natural instincts of an equine are to jump forward or sideways, backup quickly, or run away from danger by trotting or galloping. Equines are also known to kick, buck, rear up, shy, spin around, strike, or bite. I know that equines can do any of these things without warning. I also understand that all equines, even if they have no history of inflicting injury, are powerful and have the potential to be dangerous to people, equines, and animals that are on, near, or around them.

 

Further, I understand that riding, working with, handling, or even being near and equine can expose me to numerous hazards, which could include, for example: the propensity of an equine to behave in ways that may result in injury, harm, or death to persons on or around them; the unpredictability of an equine’s reaction to sounds, sudden movements, and unfamiliar objects, persons, or other animals; certain hazards such as surface or subsurface conditions; and/or collisions with other equines, animals, or objects. I understand these risks and dangers that are inherent in equine activities and I agree to assume all of them. I also understand that these are just some of the inherent risks associated with equines and equine-related activities, and I agree to assume others that are not mentioned above. I am NOT relying on this document, or any Bucklebury Horse Camp affiliate, to list all possible equine-related risks for me at any time, now or in the future.

 

3.                     WAIVER AND LIABILITY RELEASE: As consideration for being allowed (directly or indirectly) to engage in any or all of The Activities, now and in the future, I agree to assume full responsibility for any and all bodily injuries or damages which I may sustain at any time when engaging in these and other activities.  The term “damages” means, for example: medical expenses, losses incurred because of bodily injuries or property damages, and/or personal property damages.  I, for myself and my heirs, administrators, personal representatives or assigns, release and discharge Emily M. Jenkins, Stephanie Simowski, Laura Balgooyen, Julianna Kay Schlemmer, Bucklebury Horse Camp and it’s volunteers, affiliates and counselors, Constantine Farms, Mary K. Constantine (“Kathy” Constantine), and their respective members, managers, employees, agents, contractors, representatives, heirs, and others acting on their behalf of and from any and all claims, demands, damages, actions, omissions, suits, or causes of action (present and future), whether the same be known or unknown, anticipated or unanticipated, resulting from or arising out of my bodily injury or damage, or property damage which may occur at any time-now or in the future- as a result of engaging in any or all of The Activities at any location (except if such loss, injury, or damage is directly caused by a Bucklebury Horse Camp affiliate’s gross negligence or wanton and willful misconduct).

 

 

 

WARNING

 

Under the Michigan Equine Activity Liability Act [1994 P.A. 351], an equine professional is not liable for an injury to or the death of a participant in an equine activity resulting from an inherent risk of the equine activity.

 

 

 

 

 

 

WAIVER AND LIABILITY RELEASE: (continued)

 

IT IS MUTUALLY UNDERSTOOD AND AGREED THAT THE WAIVER, AGREEMENT AND LIABILITY RELEASE SET FORTH IN THIS DOCUMENT CONSTITUTES A WAIVER OF LIABILITY BEYOND THE PROVISIONS OF THE MICHIGAN EQUINE ACTIVITY LIABILITY ACT, 1994 P.A. 351.

 

 

By Signing This Waiver, Agreement and Liability Release, I agree NOT to bring any claim or suit against discharge Emily M. Jenkins, Stephanie Simowski, Laura Balgooyen, Julianna Kay Schlemmer, Bucklebury Horse Camp and it’s volunteers, affiliates and counselors, Constantine Farms, Mary K. Constantine (“Kathy” Constantine), and their respective members, managers, employees, agents, contractors, representatives, heirs, and others acting on their behalf based on any exception in that law.  In particular, I agree not to bring a claim or suit for: (1) faulty tack or equipment; (2) failure to make reasonable and prudent efforts to determine an equine activity participant’s ability to safely manage an equine; (3) a dangerous latent condition on or off of the stable property; and/or (4) any act or omission that may constitute ordinary negligence by a Bucklebury Horse Camp affiliate or those indirectly affiliated with Bucklebury (except if such loss, injury, or damage is directly caused by a Bucklebury Horse Camp affiliate’s gross negligence or wanton and willful misconduct).

 

 

4.                     INDEMNIFICATION.  I also agree to indemnify and hold harmless discharge Emily M. Jenkins, Stephanie Simowski, Laura Balgooyen, Julianna Kay Schlemmer, Bucklebury Horse Camp and it’s volunteers, affiliates and counselors, Constantine Farms, Mary K. Constantine (“Kathy” Constantine), and their respective members, managers, employees, agents, contractors, representatives, heirs, and others acting on their behalf against all damages which are sustained or suffered by any third person(s) [“third persons” are any and all persons who are not parties to this Agreement, including, but not limited to, my relatives, guests, other stable visitors or patrons, etc.], including any and all injuries or damages whatsoever that I may cause, directly or indirectly, while engaging in any or all of The Activities at any time and at any location.  The indemnification shall include reimbursement of all reasonable attorney fees.

 

5.                     ASTM/SEI Headgear and ASTM Protective Vest.  I agree to be fully responsible for my own safety at all times while on, near, or off the stable property.  I have been advised that, for my own protection, I should purchase, or borrow, and wear properly fitted and secured ASTM-standard/SEI-certified protective equestrian headgear. I have also been advised that when I am engaged in schooling, or competing in cross country activities, I should purchase and wear an equestrian protective vest that satisfies ASTM F1937-98, EN 13158:2000, and BETA 2000 Level 3 standards and a USEA arm band. I am NOT relying on anyone other than myself to provide a helmet, vest, or armband for me, to check any helmet, vest, or arm band that I may wear, or to monitor my compliance with this suggestion at any time- now or in the future.  If I choose to wear, or not to wear, an ASTM-standard/SEI-certified helmet or an ASTM standard equestrian protective vest, this my decision alone. Riding Lessons and camp sessions will not be available to students under 18 who do not have the proper protective headgear.

 

6.                     Emergencies:               

 

Person(s) to contact in case of Emergency:

 

Name: _____________________________________________

 

Phone Number(s): ____________________________________

 

Relationship: ________________________________________

 

Important Medical Conditions:

 

 

 

 

 

 

7.                     This Waiver, Agreement and Liability Release is governed by Michigan law and is intended to be as broad and inclusive as Michigan law permits.  This document can only be modified in writing and signed by Emily M. Jenkins and myself.  Should any clause is this document conflict with Michigan law, only the clause will be null and void and the remainder of this document shall stay in full force and effect at all times, now and in the future.  Should I breach this document (or any part of it) I agree to pay the attorney’s fees and court costs related to such breach that were incurred by Bucklebury Horse Camp (and/or persons directly affiliated with Bucklebury Horse Camp).  It is also mutually agreed that any disputes arising under this document, or any activities that are undertaken pursuant to this document, shall be litigated in a State or Federal Court of proper jurisdiction.

 

 

8.                     ALSO, I REPRESENT THAT (please initial):

 

______            I am at or over 18 years of age;

 

______            I am of sound mind and not suffering from shock or under the influence of alcohol, drugs,

 

or intoxicants;

 

______            I have read this entire Waiver, Agreement and Liability Release and I fully understand it;

 

______            I intend for this Waiver, Agreement and Liability Release to be valid and binding today

 

and at all times in the future; and

 

______            The information I have provided in this Waiver, Agreement and Liability Release is true

 

and accurate.

 

 

 

 

 

Bucklebury Horse Camp                     HAS                        DOES NOT HAVE            (Please circle one) my permission to use appropriate photographs of my child for promotional purposes on the Bucklebury Horse Camp web site (www.buckleburyhorsecamp.com). Please note: We will never include campers’ names, or any information relating to them on our web site.

 

 

 

Signature of Contracting Party (Parent or Guardian): __________________________________________

 

Print Name:__________________________________________________________

 

Date:________________________________________________________________

 

 

Signature of other Contracting Party (Spouse/Other Guardian): __________________________________

 

Print Name:__________________________________________________________

 

Date:________________________________________________________________

 

 

Signature of Camp Coordinator:_______________________________________

 

Date:__________________________            Dep________                         PIF_________           

 

 

PLEASE NOTE THAT IN ORDER TO COMPLETE REGISTRATION, THIS DOCUMENT MUST BE COMPLETED IN FULL, AND MUST ACCOMPANY YOUR $100.00 DEPOSIT. ALL CHECKS MUST BE MADE OUT TO EMILY JENKINS.

 

PLEASE MAIL ALL REGISTRATION FORMS TO:

 

Bucklebury Horse Camp

Emily Jenkins

27600 Marquette

Garden City, MI 48135

 

Questions or Comments may be directed to: (734) 776-8103 or buckleburyhorsecamp@gmail.com