VETERAN Equine Liability Release Form 2022-2023

Equine Release Form

7757 U.S. Rte. 136 Potomac, IL 61865 ("premises", "property")

VISITATION, PARTICIPATION AGREEMENT (the "Agreement"):

READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. IT CONTAINS LEGAL CONSEQUENCES THAT WILL AFFECT YOUR LEGAL RIGHTS AND ELIMINATE YOUR ABILITY TO BRING FUTURE LEGAL ACTIONS.

RELEASED PARTIES INCLUDE: Gateway Family Services of Illinois, Hooves of Hope, Stan & Mary Remole, Chris & Kori Campbell its agents, owners, officers, volunteers, participants, employees, landlords and property owners and all other persons or entities acting in any capacity on behalf (collectively referred to as "Gateway Family Services of Illinois").

RELEASING PARTIES INCLUDE: The undersigned participant and minor(s) listed in the Agreement, participant's spouse, children, parents, guardians, heirs, next of kin, and any legal or personal representatives, executors, administrators, successors and assigns, or anyone else who might claim or sue on participant's behalf.

AGREEMENT: IN CONSIDERATION OF THE Gateway Family Services of Illinois services: I hereby agree to release and discharge Gateway Family Services of Illinois and Chris & Kori Campbell on behalf of myself, my heirs, assigns, personal representatives, my estate and any other person listed in this Agreement (cumulatively "participant", "I", "myself"), and as follows:

RELEASE OF LIABILITY, ASSUMPTION OF RISK, INSTRUCTION, JURISDICTION, VENUE:

(1) I understand that by my presence on Gateway Family Services of Illinois premises, I may engage in activities or utilize the premises in a way that may involve inherent risks that are beyond the control of the Gateway Family Services of Illinois. Gateway Family Services of Illinois has taken precautions to provide a safe setting, but I understand that the possibility of injury, death, or loss to persons is present. Activities may include, but are not limited to, physical activity, walking/running, group games, sports, aquatic activities, general recreation, general use of grounds including its improvements, working on projects in a woodshop, baking, craft making, handling and petting dogs or cats. By signing below, I hereby give consent for the below mentioned participants to use the grounds and activities.

(2) I further agree that horseback riding, all equine activities and aquatic activities are inherently dangerous activities and that these activities will expose me to significant risks, both known and unknown, which could result in physical or emotional injury, or damage to myself, to property, or to third parties.

(3) I expressively agree and promise to accept and assume all the risks existing in Gateway Family Services of Illinois activities, both known and unknown, whether caused or alleged to be caused but neglect acts or omissions of Gateway Family Services of Illinois. My participation in all Gateway Family Services of Illinois activities is purely voluntary and I elect to participate in spite of the risks.

(4) I agree to acknowledge all of Gateway Family Services of Illinois' rules and regulations pertaining to any and all activities (equine or otherwise) occurring on or off of Gateway Family Services of Illinois’ property. I agree to and I am responsible for wearing protective gear appropriate for said activities to ensure my safety while engaging in same.

(5) I understand that protective gear includes, but is not limited to, protective headgear. I agree that Gateway Family Services of Illinois has fully warned and advised me that protective equine headgear that meets or exceeds the quality standards of SEI certified ASTM standard F1163 equestrian helmet should worn while riding, driving, training, or being near horses. I understand that wearing such headgear at these times may reduce the severity of some of the wearer's head injuries and possibly prevent the wearer's death. I am not relying on Gateway Family Services of Illinois to provide a certified equestrian helmet for me, to check any headgear or equestrian helmet that I may wear, to check any headgear strap or equestrian helmet strap that I may wear, or to monitor my compliance with this suggestion at any time now or in the future.

(6) I understand the risks, conditions, and dangers inherent in all Gateway Family Services of Illinois activities, including equine activities. I agree to assume any and all risks involved in my use of or presence upon Gateway Family Services of Illinois's property and facilities while engaging in any activity without limitation. These risks include, but are not limited to, death, bodily injury, property damage, falls, kicks, bites, unavailability of emergency medical care, the ordinary negligence of another person, and the deliberate acts of another person. I understand that if a horse is frightened or provoked it may divert from training and act according to its natural survival instincts which may include, but are not limited to, stopping short, spinning around, changing direction or speed, shifting its weight, bucking, rearing, kicking, biting, or running from danger. The same is true for other animals upon the property. I acknowledge that these are just some of the risks and I agree to assume others not mentioned above.

(7) I agree that Gateway Family Services of Illinois is not responsible for total or partial acts, occurrences, or elements of nature or unfamiliar sights, sounds or sudden movements that may scare an animal, including a horse, cause it to fall, or cause it to react in some other unsafe way. Some examples include: thunder, lightning, rain, wind; wild or domestic animals, insects, reptiles, which may walk, run or fly near, or bite or sting a horse or person; and irregular footing on out-of-door groomed or wild land which is subject to constant change in condition according to weather, temperature, and natural and man-made changes in landscape. I also acknowledge that these are just some of the risks and agree to assume others not mentioned above. I have inspected Gateway Family Services of Illinois's facilities and am satisfied that all premise conditions are reasonably safe for my intended purpose, usage and presence upon Gateway Family Services of Illinois's premises.

(8) I agree to stay out of all barns, paddocks, corrals, tack-rooms, and all other non-office related buildings while waiting for horse related or other activities or while waiting for a participant of such activities.

(9) I acknowledge that saddle girths (the fastener straps around a horse's belly) may loosen during riding. I must alert the instructor or attendant of any girth looseness so action can be taken to avoid slippage of saddle and the potential for me to fall from the horse.

(10) I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Gateway Family Services of Illinois from any and all claims, demands, or causes of action, which are in any way connected with my participation in these activities or my use of Gateway Family Services of Illinois's equipment of facility, including any such claims which allege negligent acts or omissions by Gateway Family Services of Illinois.

(11) I agree not to sue or initiate any legal action (whether in court or arbitration) against Gateway Family Services of Illinois or any present or future owners, officers, members, managers, agents, employees and representatives of Gateway Family Services of Illinois, in connection with any claim which could have been or could be raised against any of them in any way connected with, arising out of, or relating to, personal injury or damage to the maximum extent permitted by law.

(12) I certify that I have adequate insurance to cover any injury I may suffer while participating, or otherwise agree to bear the costs of such injury or damage to myself. I further certify that I have no medical or physical conditions which could interfere with my safety in this activity, or am otherwise willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition.

(13) I understand that in this Agreement the terms "horse" or "equine" mean all equine species, including, but not limited to, horses, ponies, mules, donkeys, and hinnies.

(14) I understand that this Agreement is in addition to, and not in lieu of Illinois Revised Statute, "745 ILCS 47-/" (Equine Activity Liability Act).

MISCELLANEOUS: (21) I understand that parents of minor(s) are encouraged but not required to stay on the grounds of Gateway Family Services of Illinois during their minor's visits. Given that the parent/guardian of a minor does not stay on the grounds during their minor's visits, the parent or guardian gives full legal rights to Gateway Family Services of Illinois or any present or future owners, officers, members, managers, agents, employees and representatives of Gateway Family Services of Illinois to make emergency medical decisions for the participant, including but not limited to CPR, of calling emergency response teams, and accompanying a minor to the Emergency Room if needed.

(22) I agree these releases are binding upon me, the minor(s) below for whom I am contracting, my heirs, executors, administrators, legal representatives, and successors.

(23) Should Gateway Family Services of Illinois or anyone acting on its behalf be required to incur attorney's fees and costs to enforce this Agreement, I agree to indemnify and hold them harmless for such fees and costs.

(24) I agree that the validity and enforceability of this Agreement will be governed by the substantive law of Illinois, without regard to its conflict of law rules.

(25) If a provision of this Agreement is determined to be unenforceable in any respect, the enforceability of the provision in any other respect and of the remaining provisions of this Agreement will not be impaired.

(26) I agree that any action, suit, or proceeding out of the subject matter of this Agreement will be litigated in courts located in Vermillion County, Illinois. I consent and submit to the jurisdiction of any local, state, or federal court located in Vermillion County, Illinois.

(27) Medical Treatment: Except as otherwise agreed to by Gateway Family Services of Illinois, in writing, I do hereby release and forever discharge Gateway Family Services of Illinois from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with entering onto the property of the Gateway Family Services of Illinois.

(28) Assumption of Risk: I understand that entering onto the property of the Gateway Family Services of Illinois may include activities that could be hazardous to me, including, but not limited to, potential exposure to bacteria or infectious diseases such as COVID-19. In connection thereto, I recognize and understand that activities may involve risk and I hereby assume that risk. I hereby expressly and specifically assume the risk of injury or harm in these activities and release Gateway Family Services of Illinois from all liability for injury, illness, death, or property damage resulting from entering onto the property of the Gateway Family Services of Illinois.

(29) Other: I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Illinois, and that this Release shall be governed by and interpreted in accordance with Illinois State laws. I agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release, which shall continue to be enforceable.

IN WITNESS WHEREOF, I have executed the Release as of the day and year written below.

Equine Release must be signed on the by client or parent/guardian to indicate an understanding of responsibility for any and all injuries that could occur.

Equine Release Signature:
I hereby represent that I am a client or a parent of a client having sole custody, or legal guardian ("responsible party") of the following minor, whom I am able to and do contract for:

Participant First / Last name

Email address

Please select

Address

Emergency First / Last name

Emergency Contact Phone number

By my signature below, I am acting in my capacity as the responsible Party for the aforementioned client or minor. I read and understand all of it, and by my signature I agree for myself to be bound by each one of the terms in this Agreement. I will ensure I act in accordance with this Agreement, and I am liable for my actions. I agree to save and hold harmless and indemnify each and all the parties previously referred to in this document, including without limitations Gateway Family Services of Illinois, from all liability, loss, cost, claim or damage whatsoever that may be imposed upon said parties because of any failure, or defect in or the lack of my capacity, to act in accordance with this Agreement, and I release the Gateway Family Services of Illinois and said parties.

I agree and understand that by signing the Electronic Signature Acknowledgment and Consent Form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement. I further agree my signature on this document is as valid as if I signed the document in writing. This is to be used in conjunction with the use of electronic signatures on all forms regarding any and all future documentation with a signature requirement, should I elect to have signed electronically. Under penalty of perjury, I herewith affirm that my electronic signature, and all future electronic signatures, were signed by myself with full knowledge and consent and am legally bound to these terms and conditions

Signature of participant

Date

YYYY

Please select

Please explain "other" details for your physical needs.

Verification

Equine Release must be signed on the by client or parent/guardian to indicate an understanding of responsibility for any and all injuries that could occur.

Equine Release Signature: I hereby represent that I am a client or a parent of a client having sole custody, or legal guardian ("responsible party") of the following minor, whom I am able to and do contract for:

Equine Release Signature:
I hereby represent that I am a client or a parent of a client having sole custody, or legal guardian ("responsible party") of the following minor, whom I am able to and do contract for: