ROCKFORD PARK DISTRICT WAIVER FOR LOCKWOOD - EQUINE PROGRAM

IMPORTANT INFORMATION

The Rockford Park District is committed to conducting its recreation programs and activities in a safe manner and holds the safety of participants in high regard. The Rockford Park District continually strives to reduce such risks and insists that all participants follow safety rules and instructions that are designed to protect the participant's safety. However, participants and parents/guardians of minors registering for this program must recognize that there is an inherent risk of injury when choosing to participate in recreational activities. You are solely responsible for determining if you or your minor child/ward is physically fit and/or adequately skilled for the activities contemplated by this agreement. It is always advisable, especially if the participant is pregnant, disabled in any way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity.

WARNING OF RISK

Equine activities are intended to engage the physical, mental and emotional resources of each participant. Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury, including head/brain injury, spinal cord injury, and bone and joint injuries. All hazards and dangers cannot be foreseen. Certain inherent risks include the propensity of an equine to behave in dangerous ways that may result in injury to the participant, including, but not limited to the inability to predict an equines reaction to sound, movements, objects, persons, or animals and actions by the equine due to fright, anger, stress, insect bites or natural reactions such as bucking, jumping sideways, forward or backwards, kicking, and biting. Other risks include losing balance, falling off the horse, surface or subsurface conditions, acts of God, inclement weather, slips and falls, poor mounting, dismounting or riding technique, horseplay, riding into fixed objects and being knocked off the horse, equipment failure, failure in instruction/supervision, and all other risks inherent in equine activities. In this regard, it must be recognized that it is impossible for the Rockford Park District to guarantee absolute safety.

WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK

Please read this form carefully and be aware that in signing up and participating in this program/activity, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this program/activity (including transportation services and vehicle operations, when provided). I recognize and acknowledge that there are certain risks of physical injury to participants in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in this program/activity against the Rockford Park District, including its officials, agents, volunteers and employees. I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. If registering on-line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature.

PHOTO/VIDEO AUTHORIZATION, CONSENT, AND RELEASE OF ALL CLAIMS

I hereby authorize and give my consent to the District to photograph/video me and my minor child/ward, and without limitation, to use such photographs/video in connection with promoting/advertising the services, programs, and facilities of Rockford Park District without consideration of any kind. Such productions may be copied, copyrighted, edited, and distributed by the District in the manner described above. I understand that my and my minor child’s/ward’s name, likeness, or voice may be used in the manner described above, and grant the Rockford Park District the right to use and reuse, in any manner at all, the video, motion picture, audio recording, web page, social media pages, or still photograph productions and broadcasts as described above. I hereby waive any and all rights that my minor child/ward and I may have to examine or approve the finished product or products that contain the photograph/video of me or my minor child/ward and/or the advertising copy or printed matter that may be used in connection therewith or the use to which it may be applied. I hereby forever release and discharge the Rockford Park District from any and all claims, actions, and demands arising out of or in connection with the use of said video, motion picture, audio recording, web page, social media page, or still photograph, including, without limitation, any and all claims for invasion of privacy and libel. This release shall inure to the benefit of the assigns, licensees, and legal representatives of the Rockford Park District, as well as the party(ies) for whom the Rockford Park District took the video, motion picture, audio recording, web page, social media page, or still photograph.

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Third Minor's Name

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Sixth Minor's Name

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Seventh Minor's Name

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Eighth Minor's Name

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Ninth Minor's Name

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Tenth Minor's Name

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Electronic Signature Consent *

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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