E.P.O.N.A. Beach
Ride Registration and Release Form
Use
your keyboard to fill in each field; you can tab from field to field.
When
done, print and sign the form and mail it, with a check made payable to
E.P.O.N.A., to:
E.P.O.N.A., PO Box 315, Epping, NH 03042-0315 OR fax it to
603-679-5178.
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you can't view this form or aren't able to use it, CLICK HERE.
Full Name:
Is Rider Under 18? (Yes or NO)
Home Phone #:
E-Mail Address:
Street Address or PO Box:
City, State and Zip Code:
In case of an emergency, we should contact:
Name 1:
Phone #:
Name 2:
Phone #:
Please check one of the following:
Ride and Brunch ($25.00)
Walk and
Brunch ($20.00)
Please note there is a $7.00 parking fee for the
State of Massachusetts Parks & Recreation Department.
E.P.O.N.A. is a 501(c)(3) and therefore donations
may be tax-deductible. Consult your tax professional.
GENERAL LIABILITY RELEASE
This
release of Liability is made and entered into on this ____ day of
_________________, _______, by
and
between between E.P.O.N.A./Wendell�s Wish and
____________________________, hereinafter
referred to as the Rider; and if the Rider is a minor, the Rider�s Parent or
Guardian,
_________________________________. In return for the use today, and on all
future dates of the
property, facilities, and
services of E.P.O.N.A., the Rider, his/her heirs, assigns, and legal
representatives, herby
expressly agree to the following:
Rider
and or Guardian agrees to assume ANY AND ALL RISKS INVOLVED IN OR ARISING
FROM RIDER�S USE OF OR PRESENCE UPON E.P.O.N.A. PROPERTY, EVENTS AND
FACILITIES including without limitation but not limited to, the risks of
death, bodily injury, property damage, falls, kicks, bites, collision with
vehicles, horses, or stationary objects, fire or explosion, the unavailability
of emergency medical care, or the negligence or deliberate act of another
person.
Rider
or Guardian, agrees to hold E.P.O.N.A. and all it�s volunteers, employees,
board members, successors, assign, subsidiaries, franchises, affiliates,
officers, directors and agents, completely harmless, and not liable and
release them from all liability whatsoever, and AGREES NOT TO SUE them
on account of or in connection with any claims, causes of action, injuries,
damages, costs or expenses arising out of Rider�s use of or presence upon
E.P.O.N.A.�s property, events and facilities, including without limitation
those based on death, bodily injury, property damage, including consequential
damages, except if the damages are caused by direct, willful, and wanton
negligence of E.P.O.N.A.
Rider or Guardian agrees to wave the protection afforded by any statute or
law in any jurisdiction (e.g. Calif. Civil Code S 1542) whose purpose,
substance, and/or effect is to provide that a general release shall not extend
to claims, material or otherwise, which the person giving the release does not
know or suspect to exist at the time of executing the release.
Rider
or Guardian agrees to indemnify and defend E.P.O.N.A. against, and hold it
harmless from, any and all claims, causes of action, damages, judgments, costs
or expenses, including attorney�s fees, which in any way arise from Rider�s
use of/or presence upon E.P.O.N.A.�s property, events and facilities.
Rider
or Guardian agrees to abide by all of the E.P.O.N.A. rules and regulations.
Rider, if using his/her horse shall be free from infection, contagious or
transmissible diseases. E.P.O.N.A. reserves the right to refuse the Rider�s
horse if not in proper health or is deemed dangerous or undesirable.
A current negative
Coggins (within past 6 months) is required and will be enforced.
All
dogs must be on a leash.
This contract is non-assignable and non transferable, and is made and entered
into the State of New Hampshire, and shall be enforced and interpreted under
the laws of New Hampshire. Should any clause be in conflict with State Law,
that clause is null and void and the remainder of the contract valid. When
signed by all parties stated above, then this contract will be binding on all
parties, subject to the above terms and conditions.