Rider Release

This is a General Release and Hold Harmless Agreement entered between you, the rider and Jan Brubacher, North Road Farm, 370 North Road, Fremont NH
  • Each HORSEBACK RIDER or VOLUNTEER must complete this release. If you are not 18 years, an adult must approve with her/his name at the end of this release.
    MM slash DD slash YYYY
  • If you are riding with a group or your ticket was purchased by someone else, please share their name(s) here:
  • How would you describe you level of stamina, strength, flexibility, aerobic capacity and general heath?
  • Each box you check means you know how to do this riding a horse. Do not check a box if you do not know what the skill means.
  • Choose all that apply.
  • What horseback riding experience are you going to do?
  • I hereby agree to, in exchange for the use and enjoyment of Jan Brubacher's property, horses, dogs and cats, facility, equipment, services, instruction, training for today and all future dates, whether for fee or no fee, you and parent/guardian of you and your heirs, assigns hereby release, hold harmless and indemnify Jan Brubacher, her agents, employees and assigns for any and all activity in any way related to equine activities, including but not limited to any activity for which you and parent/guardian may be present on Jan Brubacher's premises, including as a volunteer or spectator. 1. Signature(s): If only one parent signs this agreement, that parent represents that she or he have the authority to sign on behalf of and hereby bind both parents. 2. Rules & Regulations are agreed to and abided by you, parent/guardian, other family members and friends. 3. Health and Personal Insurance is carried by you or parent/guardian and is in enforce for your physical self and personal property. 4. Horses, Horseback Riding and Volunteering are dangerous activities and you or parent/guardian agree to participate. Perils that may or may not happen to you while on foot include: stepped on, bitten, shoved, knocked over. Perils while mounted include: sliding or falling off, shock or trauma associated with breathing, concussion to head and/or injury to body that may or may not require professional medical treatment. While Jan will make sure you feel and are prepared, you or parent/guardian are solely responsible for your health and safety. Should Jan need to call an ambulance for emergency service, you give Jan permission to do this: Yes No 5. Horseback Riding challenges that you may or may not be exposed to include: mount and dismount, ride walk, trot/jog, canter/lope, gallop, jump, cross roads, trails, water, wood, stone, tunnel and other naturally occurring obstacles. 6. Volunteer Participation: You are under no compulsion to volunteer and yet choose to do so. You understand that any work done on Jan Brubacher's property is done without monetary compensation and does not make you and employee or agent of Jan Brubacher. 7. Assumption and Acceptance of All Risk is made by you or parent/guardian by your involvement in or in any way arising from your use of, or presence upon, the property, facility and services of Jan Brubacher including but not limited to bodily injury, death, property damage, the unavailability of emergency medical care or any other loss or damage, even if the method of injury or loss or the nature and extended thereof are not contemplated at the time of the signing of this agreement. 8. New Hampshire Equine Law RSA 508:19 is acknowledged by you or parent/guardian and that those rights extent to and beyond to greatest extent permitted by New Hampshire state law. 9. Claims of Any Kind will not be brought by you or parent/guardian against Jan Brubacher, her agents or employees out of any and all activity in any way related to horses, riding or volunteering on or off Jan Brubacher's property including those but not limited to activities for which parent/guardian have chosen to leave Jan Brubacher's property and are NOT present on during activities. 10. Negligence: Notwithstanding anything contained with, you or parent/guardian understand that this agreement is intended to and does extend to claims of any kind, including negligence of Jan Brubacher, her agents and employees, whether allegedly due to their actions or the actions of third parties. By signing this, you or parent/guardian understand that Jan Brubacher, her agents or employees will not be responsible for the consequence of their own negligence. 11. Contract: A contract is constituted by this agreement and entered into the State of New Hampshire and shall be enforced and interpreted under the laws of this state. Should any clause be declared invalid by a New Hampshire court, all other clauses shall remain in full force and effect.

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