Pennsylvania Percheron

Association

Release and Hold Harmless Agreement

Whereas, the undersigned acknowledges the inherent risks involved in driving/riding and
working around horses, which risks may include bodily injury from using, driving, riding or
being in close proximity to horses, among other risks, and further, that both horse and
participant can be injured in normal use or in competition and schooling;

For the privilege of attending the Percheron Clinic and obtaining instruction on driving,
riding and/or working around horses at the Pennsylvania Percheron Association Youth Clinic
located at Centre County Grange Fair Centre Hall, PA the undersigned does hereby agree
to hold harmless and indemnify Terry and Gail Woodring, Walt Rupert, Roger and Linda
Thoms, Luke Vastine, Pennwood Percherons and any other person bringing horses to the
clinic and the Pennsylvania Percheron Association and the Percheron Horse Association of
America and further release them and their heirs, executors, administrators, successors and
assigns from any and all liability or responsibility whatsoever for accident, damage, injury,
death or illness to the undersigned or to any family member or spectator accompanying the
undersigned while at the Pennsylvania Percheron Clinic held on May 8th, 2010.

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Signature (s)

___________________________________________________________________________
Print name (s)

______________________________
Street or Mail Box

______________________________
City, State, zip code

Parent or Guardian, if under Eighteen (18) years of age: ______________________________

______________________________
Date