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Agreement for Equine Boarding William O. Autry & Sarah
E. Leach This agreement is made and entered into by and between ______________________________,
(Boarder/Owner of Horse), hereinafter designated "Horse Owner", and Chez
Chevaux Farm, hereinafter designated as the "Farm". This agreement
covers the horse(s) described as follows:
The Horse Owner agrees that Horse Owner and Chez Chevaux Farm mutually agree that
Emergency Care First Choice ___________________________________________________________________
If none of the above listed veterinarians is available, the Farm, acting as an agent of the Horse Owner, is authorized to contact an alternate veterinarian. Limitations to Emergency Care (1) Do everything
possible to save the life of the horse, no matter what the cost or time
involved. Yes No
(2) Do everything
possible to administer aid to the horse, e.g., broken leg, but
immediate loss of life not eminent. Yes
No
(3) Leave the choice
to the attending vet as to whether it is feasible to use drastic care measures
or euthanize the horse. Please indicate if you wish a second opinion .
Yes No
(4) Is there a dollar
($) limit that you do not wish to exceed in emergency care? e.g.,
the vet states that leg is broken and may be saved, or that the
horse has colic and may be saved by surgery at the farm or hospital,
but the initial cost will be $XXXX and continued care cost is unknown.
Remember that even if there are complications during emergency care and
costs exceed this amount, you are responsible as the Horse Owner.
Amount $_____________
(5) If the horse needs to be transported to a veterinary hospital, who do we contact to move the horse?
(6) Is the horse covered by insurance? If so, what is the name of the company and the telephone contact number for the company?
(7) Additional Guidelines and Comments:
Signatures & Contact Information ____________________________________________ _______________________
Address__________________________________________________________________
Telephones ___________________________(home) _____________________________(work)
_____________________________________________ _______________________
WAIVER OF LIABILITY AND ASSUMPTION OF RISK Chez Chevaux Farm, 20170 Whitmer Road, Centre Township, Saint Joseph County, South Bend, Indiana 46614-4815 I, the undersigned, wish to ride horses. I understand that riding horses involves accepting certain risks. Those risks include, but are not limited to, the risk of injury resulting from falling from a horse, being stepped on or kicked by a horse, from a horse running into fences, trees, or buildings, and injuries resulting from tripping or falling over obstacles in the riding areas. In addition, I understand that the injuries sustained from riding horses could be serious or could even result in death. Despite this and other risks, and fully understanding such risks, I wish to ride horses. I hereby assume all the risks of riding horses. I also hereby hold harmless the horse owner, if not my own horse, and the owners of Chez Chevaux Farm, and agree to defend them against any claims or actions resulting from my riding horses, including all expenses and attorney fees. I hereby release Chez Chevaux Farm, owners Sarah E. Leach and William O. Autry, Jr., and other horse owners with animals stabled there from any and all liability, and I understand that this release shall be binding upon my estate and all my representatives. I further acknowledge and understand that any horse activity, including, but not limited to, feeding, grooming, handling, even being in close proximity to horses, carries a certain amount of risk. I fully accept this risk for myself and any guests with me. I release Chez Chevaux Farm, its owners, and/or other horse owners with animals stabled there from any and all liability for any injury or death that may occur from such horse activities while on the premises and indemnify and hold Chez Chevaux Farm, its owners, and/or other horse owners with animals stabled there harmless against any such liabilities, such indemnification to include attorney fees. I hereby certify to Chez Chevaux Farm, its owners, and other horse owners with animals stabled there that I am in good health and do not suffer from any physical limitation that could be aggravated by riding horses. This release applies to the owners of horses on the premises of Chez Chevaux Farm, to the owners of Chez Chevaux Farm, to owners of any equipment on the premises of Chez Chevaux Farm, and to any of their heirs, successors, and assignees. I agree to ask the owners of Chez Chevaux Farm for clarification of any rule or safety procedures, for further instruction as regards anything that I do not understand about the equipment and the animals, or as regards anything else that may affect the safety of, or riding of, horses on the premises. I also acknowledge that the owners of Chez Chevaux Farm strongly recommend the use of relevant equine safety gear, such as helmets, but do not specifically require its use. As such, I accept full responsibility for any and all injuries whether or not I choose to accept this recommendation. I have fully read this Waiver of Liability and Assumption of Risk carefully and understand that by signing below I am agreeing, on behalf of myself, my estate, my heirs, representatives and assigns not to sue Chez Chevaux Farm, its owners Sarah E. Leach and William O. Autry, Jr., and/or horse owners with animals stabled there, or to hold him/her/them liable for any injury, including death, from riding horses. I understand the terms of this waiver of liability and assumption of risk, and I intend to be fully bound by this agreement. Warning Under Indiana law, an equine professional is not liable for any injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities. By virtue of my signature, I acknowledge and agree to all terms and conditions set forth on this form and further acknowledge that I have carefully read this agreement and understand what I am signing. Signature __________________________________________________________ Date ________________________ Date of birth (if < 18 years of age) ________________________________________ Parent(s) or Guardian of Minor Applicant Signature(s) _______________________________________________________
(Please print) Name(s) ________________________________________________________________________________ Street Address __________________________________________________
Telephones ___________________________(home)
______________________________ (work) |
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