CLINICS AT CAUMSETT

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LIABILITY RELEASE AND ACKNOWLEDGMENT

I, the undersigned riding student or participant of activities during Clinics At Caumsett, and being an adult individual (or in the case of a minor child being the parents or guardian of said riding student), acknowledge that horseback riding and training (including being in the vicinity of a horse while not riding) is an activity involving the risk of serious or fatal bodily injuries. I understand that horses are unpredictable and therefore pose a potential danger to myself and others. I fully realize that any participation in equine sports and related activities is at my own choosing and risk. Nevertheless, I desire that Linda Adkins, John Rooney, Lesley Woodworth, and all associated parties related to and with Clinics At Caumsett, provide the service of horseback riding instruction and lessons to myself or schools my horse(s) while riding them or from the ground, and I assume the risk as set forth throughout this release. I will not hold Linda Adkins, John Rooney, Lesley Woodworth, their associates, agents, servants, employees, representatives, assigns; or any property and business owners (including New York State, Caumsett State Historic Park, or Lloyd Harbor Equestrian Center), responsible for any loss, injury, or death to myself or my animals, sustained on any premises during lessons, clinics, trail riding, or schooling both on and off of the property, nor during any transportation to and from, and also on-site at, any competition or outings. I release and forever discharge all of the above from any liability, responsibility, or any claim for accident, damage, injury, or illness. I agree to hold harmless all of the above against claims of any nature resulting from or arising out of the activities which arise of or in connection with my involvement in one or more of the above mentioned tasks. This includes any and all claims of every kind, nature and character which I may have or may hereafter acquire or have accrued to them, for any and all damages, losses, and injuries which may be suffered or sustained by me, my property, or by the horse(s) utilized in connection with my participation in any of the above tasks or during Clinics At Caumsett. All such claims are hereby waived and released, and I covenant not to sue therefore. I have filled out the MEDICAL RELEASE FORM. I agree to always wear an ASTM/SEI certified helmet with a secured harness while riding, plus a protective vest during Cross-Country. I agree to all payment policies. ADULT RIDER RELEASE AND WAIVER: Printed Name of Adult Rider (21 years old and over) _______________________________________ Full Address _________________________________________________________________________ Home Phone (____)______________ Work Phone (_____)___________Fax (_____)______________ Signature of Adult Rider (21 years old and over)________________________DATE_______________

Parent or Guardian - Release and Waiver: I am the parent or guardian of _____________________, a minor, and have read the foregoing on the minors behalf, and on my behalf and also on the behalf of all other parents and guardians of the minor. I accept the release and waiver of liability above as an inducement for allowing my child to ride and to be involved in and around equine sports. Printed name of child (under 21 years old)________________________________________________ Full Address_________________________________________________________________________ Home Phone (____)_____________ Work Phone (_____)___________Fax (_____)_______________ Printed name of Parent or Guardian ____________________________________________________ Signature of Parent or Guardian ___________________________________DATE________________ 1