Name (Parent or Legal Guardian) *

First Name

Last Name

Minor's Name (if applicable)

First Name

Last Name

Phone Number

(###)

###

####

I agree *

I hereby attest that I am aware of the risks of head injury during Equine Activities/Competitions, and of the physical and mental incapacity that can result from head injuries, including a significantly increased risk of death. I have been advised that wearing an ASTM/SEI approved riding helmet while engaged in Equine Activities/Competitions can significantly reduce my risk of, and severity of, head injuries suffered in falls from horses or other blows to the head during Equine Activities/Competitions. Notwithstanding this knowledge and specific advice to wear a protective helmet while engaging in Equine Activities/Competitions, I consciously and voluntarily choose not to wear such a helmet during Equine Activities/Competitions.

I agree *

I acknowledge that I do so against the advice of Beyond the Gaits, and I hereby assume ALL RISKS OF THIS DECISION. Further, I hereby waive any claims against Beyond the Gaits and any of their representatives, family, land and assets, and release Beyond the Gaits from any claims or liability whatsoever with regard to damages that could have been prevented or avoided by the proper use of a protective helmet.

I agree *

This assumption of risk, waiver of claims and release of liability agreement for declining to wear a protective helmet is in addition to, and it does not replace or in any way modify Beyond the Gaits' assumption of risk, release of liability, and indemnity agreement executed by me on behalf of Beyond the Gaits and others, and shall remain in effect until specifically revoked by me.

I agree *

I HAVE READ THIS ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY, AND I UNDERSTAND THAT IT IS RELEASE OF CLAIMS AND THAT I AM ASSUMING RISKS INHERENT TO MY OR MY CHILDS PARTICIPATION WITHOUT THE USE OF PROTECTIVE HEAD GEAR, AND I AGREE TO BE FULLY BOUND BY ITS TERMS.

Authorized Signature *

First Name

Last Name

Date *

MM

DD

YYYY

Electronic Signature *

By including my typed name, I hereby provide my electronic signature and agree to the terms of this document.

I agree