TWIN PALMS FARM, LLC
6438 HWY 561
LOUISBURG, NC 27549
(919)-727-1005
RELEASE AND HOLD HARMLESS AGREEMENT
NAME: _________________________________________________________________
ADDRESS: _____________________________________________________________
CITY:______________________ STATE: __________________ ZIP: ______________
PHONE: _____________________________ (H) ____________________________(W)
EMERGENCY CONTACT: ________________________________________________
IF MINOR, INDICATE AGE: ______________
ACTIVITIES IN WHICH INVOLVED (CHECK):
BOARDING ______ LESSONS ______ SHOWS ______ CLINICS ______
OTHER (INDICATE ACTIVITY) _____________________________________
PHYSICAL LIMITATIONS: _______________________________________________
MEDICAL CONDITIONS/ALLERGIES: _____________________________________
The Undersigned assumes the unavoidable risks inherent in all horse-related activities, included but not limited to bodily injury and physical harm to horse, rider and/or spectator. Under North Carolina law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in the equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina General Statutes.
In consideration therefore, of the privilege of riding and/or working around horses, the Undersigned does hereby agree to hold harmless and indemnify Twin Palms Farm and Debora Hayward, their agents and employees (hereinafter "the Indemnities") for any loss or damages incurred by the Indemnitee(s) as a consequence of the Undersigned’s riding or working around horse(s) at the premises of Twin Palms Farm, LLC (Hereafter "the Premises"). The Undersigned agrees to further release the above mentioned from any liability of any kind (including costs of defense) or responsibility for accident, damage, or illness to the Undersigned or to any horse owned by the Undersigned or to any family member or spectator accompanying the Undersigned to the Premises.
In the unexpected event of a medical emergency, the employees or agents of Twin Palms Farm, LLC have permission to seek and authorize medical attention and services for the Undersigned or any horse owned by the Undersigned.
Nothing herein shall be construed so as to obligate Indemnitee(s) to allow the Undersigned to continue riding or working around horses on the Premises without the express consent of the Indemnitee(s).
________________________________________________________________________
SIGNATURE DATE
________________________________________________________________________
PARENT/
6438 HWY 561
LOUISBURG, NC 27549
(919)-727-1005
RELEASE AND HOLD HARMLESS AGREEMENT
NAME: _________________________________________________________________
ADDRESS: _____________________________________________________________
CITY:______________________ STATE: __________________ ZIP: ______________
PHONE: _____________________________ (H) ____________________________(W)
EMERGENCY CONTACT: ________________________________________________
IF MINOR, INDICATE AGE: ______________
ACTIVITIES IN WHICH INVOLVED (CHECK):
BOARDING ______ LESSONS ______ SHOWS ______ CLINICS ______
OTHER (INDICATE ACTIVITY) _____________________________________
PHYSICAL LIMITATIONS: _______________________________________________
MEDICAL CONDITIONS/ALLERGIES: _____________________________________
The Undersigned assumes the unavoidable risks inherent in all horse-related activities, included but not limited to bodily injury and physical harm to horse, rider and/or spectator. Under North Carolina law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in the equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina General Statutes.
In consideration therefore, of the privilege of riding and/or working around horses, the Undersigned does hereby agree to hold harmless and indemnify Twin Palms Farm and Debora Hayward, their agents and employees (hereinafter "the Indemnities") for any loss or damages incurred by the Indemnitee(s) as a consequence of the Undersigned’s riding or working around horse(s) at the premises of Twin Palms Farm, LLC (Hereafter "the Premises"). The Undersigned agrees to further release the above mentioned from any liability of any kind (including costs of defense) or responsibility for accident, damage, or illness to the Undersigned or to any horse owned by the Undersigned or to any family member or spectator accompanying the Undersigned to the Premises.
In the unexpected event of a medical emergency, the employees or agents of Twin Palms Farm, LLC have permission to seek and authorize medical attention and services for the Undersigned or any horse owned by the Undersigned.
Nothing herein shall be construed so as to obligate Indemnitee(s) to allow the Undersigned to continue riding or working around horses on the Premises without the express consent of the Indemnitee(s).
________________________________________________________________________
SIGNATURE DATE
________________________________________________________________________
PARENT/