LATTA PLANTATION EQUESTRIAN CENTER

COUNTRY TIME CARRIAGES, LLC

6201 SAMPLE ROAD, HUNTERSVILLE, NC 28078

LIABILITY WAIVER AND RELEASE

 

In consideration of the covenants herein contained and agreement with Latta Plantation Equestrian Center, Country Time Carriages, its officers, agents, and employees, that

____ I, ____ Parent or Guardian ______________________________________________________

   (Check appropriate category)    (Please print your name)

 

being at least age of eighteen (18) do hereby release and discharge Latta Equestrian Center, Country Time Carriages, LLC, its officers,, agents and employees from all claims, demands, actions, judgments and executions which the undersigned ever had, or now has, or may have, or which the undersigned’s heirs, executors, administrators, or assigns may have, or claim to have, against Latta Equestrian Center, Country Time Carriages, LLC, all owners, it’s successor’s or assigns, for all personal injuries, known or unknown and injuries to property, real or personal, caused by or arising out of the described activities, being horseback riding, horse-drawn wagon rides, pony rides, tractor-drawn hay rides, etc.

 

Name(s) of Rider(s):    ___ Self, or : _________________________________________________________

 

WARNING:  Under North Carolina law, an equine activity sponsor or equine professional is not liable for an injury or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities.  Chapter 99E of the North Carolina General Statutes.

Riding Helmets are available to all riders.  Helmets are mandatory for those under 18 years of age and optional for those 18 years of age or older.   It is understood that should you choose not to where a riding helmet, any resulting accident or injury is the sole responsibility of the rider with no recourse to Latta Plantation Equestrian Center, Country Time Carriages, its officers, agents or employees.

I/We, the undersigned, have read this release and understand all of its terms.  I execute it voluntarily and with full knowledge of its significances.

 

This ______ day of ________________, 2010.

 

Signature:  _____________________________________________________

   _______  Parent     ________ Guardian   _______ Self

Address:  ______________________________________________________________________________________

                                                                                                                                      City                   State         Zip

Phone:  _____________________          _____________________ 

 

E-mail: _______________________________________________________________________________

 

MAY WE SEND YOU EVENT INFORMATION VIA E-MAIL?:    Y  / N

 

Office Use:  ___ TR   ___  AR   ___  Pony ___   Hay Ride   ___   Other: ___________________