Equine Activity Release and Hold Harmless Agreement

Joy Meadows, Inc. and Pediatric Connections OT Services, PA SERVICE PROVIDER NAME, hereinafter known as “Provider(s)” Joy Meadows, 12400 170th St, Linwood, KS 66052 Location or Address of “PROVIDER(S)”

READ CAREFULLY BEFORE SIGNING

A. REGISTRATION OF CLIENT AND AGREEMENT PURPOSE, I, the following listed individual, and the parents or legal guardians thereof if a minor, do hereby voluntarily agree to participate in prescribed occupational therapy with use of hippotherapy services, hereinafter known as a client of THIS PROVIDER, and that I will utilize horses and animals provided by THIS PROVIDER for hippotherapy services purposes.
B. AGREEMENT SCOPE AND TERRITORY AND DEFINITIONS. This agreement shall be legally binding upon me the registered client, and the parents or legal guardians thereof if a minor, my heirs, estate, assigns, including all minor children, and personal representatives; and it shall be interpreted according to the laws of the state and county of THIS PROVIDER’S physical location. This agreement is intended to be valid and binding at all times now and in the future when THIS PROVIDER permits me (directly or indirectly) to enter THIS PROVIDER’S property, be on THIS PROVIDER’S property, be near any horse, receive training instruction, receive prescribed occupational therapy with use of hippotherapy services or guidance from its associates and / or when I am near horses on or off of THIS PROVIDER’S property. Any disputes by the client shall be litigated in, and the venue shall be the county in which THIS PROVIDER is physically located. This agreement is intended to be as broad and inclusive as the law permits. If any clause, phrase, or word is in conflict with state law, then that single part is null and void. The terms “HORSE” and “EQUINE” herein shall refer to all equine species. The terms “I”, “WE”, “ME”, “MY” shall herein refer to the above registered client and the parents or legal guardians thereof if a minor.
C. INHERENT RISKS / ASSUMPTION OF RISKS I / WE ACKNOWLEDGE THAT: I understand the potential dangers that I could incur in mounting, riding, walking, feeding horses; including, but not limited to, any interactions with other horses or any other activities performed on the property. Understanding those risks I hereby release THIS PROVIDER, its officers, directors, shareholders, employees, volunteers, and anyone else directly or indirectly connected with the company from any liability whatsoever in the event of injury or damage of any nature (or perhaps even death) to me or anyone else caused by or incidental to my electing to mount and ride a horse owned or operated by THIS PROVIDER. I am not relying on THIS PROVIDER to list all possible risks for me.
D. PROTECTIVE HEADGEAR / HELMET WARNING I / WE AGREE THAT: I for myself and on behalf of my child and / or legal ward have been fully warned by THIS PROVIDER that protective headgear / helmet, which meets or exceeds the quality standards of the SEI CERTIFIED ASTM STANDARD F 1163 Equestrian Helmet, should be worn while riding, driving, training and being near horses, and I understand that the wearing of such headgear / helmet at these times may reduce severity of some of the wearer’s head injuries and possibly prevent the wearer’s death from happening as the result of a fall and other occurrences.
E. LIABILITY RELEASE I / WE AGREE THAT: In consideration of THIS PROVIDER allowing my participation in this Animal-Assisted activity, under the terms set forth herein, I, the CLIENT, for myself and on behalf of my child and / or legal ward, heirs, administrators, personal representatives or assigns, do agree to release, hold harmless, and discharge THIS PROVIDER, its owners, agents, employees, officers, directors, representatives, assigns, members, owners of premises and trails, affiliated organizations, and Insurers, and others acting on their behalf (hereinafter, collectively referred to as”Associates”), of and from all claims, demands, causes of action and legal liability, whether the same be known or unknown, anticipated or unanticipated, due to THIS PROVIDER’S and / or ITS ASSOCIATE’S ordinary negligence or legal liability; and I do further agree that except in the event of THIS PROVIDER’S gross negligence and / or willful and / or wanton misconduct, I shall not bring any claims, demands, legal actions and causes of action, against THIS PROVIDER and ITS ASSOCIATES as stated above in this clause, for any economic and non-economic losses due to bodily injury and / or death and / or property damage, sustained by me and / or my minor child or legal ward in relation to the premises and operations of THIS PROVIDER, to include while riding, driving, training, handling, or otherwise being near horses owned by me or owned by THIS PROVIDER, or in the care, custody or control of THIS PROVIDER, whether on or off the premises of THIS PROVIDER, but not limited to being on THIS PROVIDER’S premises.
F. EQUINE ACTIVITY LIABILITY ACT [EALA] WARNING OR LANGUAGE: Under Kansas law, there is no liability for an injury to or the death of a participant in domestic animal activities resulting from the inherent risks of domestic animal activities, pursuant to K.S.A. 60-4001 through 60-4004. You are assuming the risk of participating in this domestic animal activity. Inherent risks of domestic animal activities include, but shall not be limited to: The propensity of a domestic animal to behave in ways i.e., running, bucking, biting, kicking, shying, stumbling, rearing, falling or stepping on, that may result in an injury, harm or death to persons on or around them; the unpredictability of a domestic animal’s reaction to such things as sounds, sudden movement and unfamiliar objects, persons or other animals; certain hazards such as surface and subsurface conditions; collisions with other domestic animals or objects; and the potential of a participant to act in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the domestic animal or not acting within such participant’s ability.
G. MEDICAL INSURANCE I/ WE AGREE THAT: Should medical treatment be required, I and / o my medical insurance company shall assume responsibility for ALL such incurred expenses. All Clients, Parents, or Legal Guardians must sign below after reading this entire document.

Signer Statement of Awareness

I / WE, THE UNDERSIGNED, REPRESENT THAT I / WE HAVE READ AND DO UNDERSTAND THE FOREGOING AGREEMENT, LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT, I / WE UNDERSTAND THAT BY SIGNING THIS DOCUMENT I AM GIVING UP RIGHTS TO SUE TODAY AND IN THE FUTURE. I / WE ATTEST THAT ALL FACTS ARE TRUE AND ACCURATE. I AM SIGNING THIS WHILE OF SOUND MIND AND NOT SUFFERING FROM SHOCK, OR UNDER THE INFLUENCE OF ALCOHOL, DRUGS OR INTOXICANTS.

For Participants Over the Age of 18

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Parent/Legal Guardian or Representative Signature

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