Liability Form

This following page must be completed and submitted before registration can be complete

Prairie School Road Farm LLC

Day Camp/Riding Lesson Waiver of Liability

and Express Assumption of Risk

THIS RELEASE CONTAINS IMPORTANT LIMITATIONS OF LEGAL LIABILITY

We acknowledge that competitive and pleasure horse riding contains inherent risks of injury to me/child. I accept that working in an agricultural environment, around horses, and other animals involves certain inherent risks. These risks include, but are not limited to, the risks of possible injury as a result of contact with nails, other metal objects, stinging insects, or from over exertion or environmental conditions. Despite these risks, I still choose to allow my child to engage in these activities. I know of no physical limitations that should keep me/child from engaging in these activities. In consideration for me/my child being allowed to participate in these activities, I hereby personally assume all risk, whether foreseen or unforeseen, for any harm, injury, or damage that may befall me/my child as a participant. I hereby release, on behalf of myself, my child, my heirs, executors, administrators, and assigns, Prairie School Road Farm LLC, directors, employees and volunteers, from any and all liability for any injury, death, or other damages to me, my child, my family, heirs, or assigns that may occur as a result of me/my child’s participation in these activities, a result of product liability, or the negligence of any party, including Prairie School Road Farm LLC, whether passive or active.

I further agree, on behalf of myself, my child, my heirs, executors, administrators, and assigns, that I will defend, indemnify, and hold Prairie School Road Farm LLC and its directors, employees and volunteers harmless against any claims, demands, and causes of action, including court costs and attorney’s fees, directly or indirectly arising from and actions or proceedings brought by or prosecuted for my benefit contrary to this release.

Further, I do hereby acknowledge that this release will extend to any accidents, damages, or claims arising out of me/my child’s participation in equestrian activities on Prairie School Road Farm LLC property caused by me/my child’s act or acts of any animal within me/my child’s control. It is further understood that the undersigned will assume full responsibility for any such action, including payment of cost.

I acknowledge that I have read the equine activity liability act of Missouri warning. “Under Missouri Law, and equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities pursuant to the Revised Statues of Missouri.”

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS WAIVER OF LIABILITY AND ASSUMPTION OF RISK BY READING IT BEFORE I SIGNED IT ON BEHALF OF MYSELF/MY CHILD.

I/we are the parents or legal guardians of _______________________________ and he/she has my permission to participate in equestrian activities and other activities at Prairie School Road Farm LLC. I/we have read and agree to the provisions stated above, and expressly agree that the terms and conditions of said releases and waivers shall apply to and be binding upon me and my minor child, insofar as it pertains to me/my child’s participation and to any injury or damage of said participant/ minor child or horse may sustain as a result of said participation.

Participant’s Name___________________ Address__________________________

Name/s of Parents or Legal Guardian: ______________________________, ___________________________ Phone #____________

Participant Signature _______________________________Date__________________

Parents/Legal signature(s) (1)______________________________________,

(2)___________________________________Date ______________________

Alternative/Emergency Contact Name and Phone Number_________________________

________________________________________________________________________