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The Willowdale Steeplechase

Willowdale Waiver of Liability and Indemnity


AGREEMENT FOR RELEASE, WAIVER OF LIABILITY AND INDEMNITY, AND ASSUMPTION OF RISK

I hereby request permission to participate in The Willowdale Point to Point. I fully understand that these activities are very dangerous activities. I desire to participate in these activities knowing that they are dangerous. I knowingly and voluntarily accept and assume all risks of injury (including death) to me or my property. In consideration of the privilege of participating in these activities, I do, for myself, my heirs, legal representatives and related entities, hereby release, forever discharge and agree not to make or bring any claim of any kind against The Willowdale Steeplechase, Inc., Landhope Investors, or any owners, partners, shareholders, members, employees and/or guests, directly or indirectly related associated therewith (hereinafter “releases” or “indemnities”) for any injury (including death) to me or any damage to my property, including horses or other animals, whether from anyone’s negligence or not, or any other cause of action or claim arising out of my participation in these dangerous horseback riding/racing and/or related activities. The term “claim” shall include loss, liability, damage, expense, fees, medical/hospital expenses, cause of actions, or suits of any nature whatsoever. The term “injury” shall include any damage or harm to any person or property or loss of life to any person, horse or other animal or any loss of property. The term “related entities” shall include the undersigned, an entity in which the undersigned has an economic interest, any person performing services for the undersigned, whether as employee, agent, servant or independent contractor, including trainers, jockeys, riders, etc. The connection with the aforesaid, the undersigned does hereby undertake and agree to forever indemnify and hold harmless releasees/indemnitees from and against any claim for any injuries sustained by any person, property or related entities.

I certify that I am


In order for the Willowdale Point to Point to allow me to participate in such races, I represent that I am properly trained and competent to ride in such races without endangering myself or other participants. I further represent that the horses I will ride are properly trained for the endeavor and will provide a safe conveyance without unduly jeopardizing my safety or that of others. I also understand that it is my responsibility to wear an SEI/ASTM approved helmet (NSA approved helmet accepted) and a protective vest, and my mount must wear an overgirth.

I further certify that I am currently covered by

Insurance Carrier

Policy#

Insurance Phone#



Emergency Contact Name

Emergency Contact Cell Number


Legal Street Address

City, State, Zip  

Your Phone #

Note: Children under eighteen (18) years of age must have their names listed and a parent or guardian must sign form.

Name of Minor (if applicable)

The undersigned, having fully read and understood the foregoing, and intending to be legally bound hereby, has set his/her hand and seal this 17th day of October, 2020.

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The Willowdale Steeplechase https://willowdalesteeplechase.org
Signature Certificate
Document name: Willowdale Waiver of Liability and Indemnity
lock iconUnique Document ID: 218e6f269a2b237f632d5b59ff0aa78244701ed0
Timestamp Audit
October 3, 2020 2:44 pm EDTWillowdale Waiver of Liability and Indemnity Uploaded by Leslie White Race Director - lesliewhite@willowdale.org IP 108.16.10.149