Burgundy Hollow Farm, Inc. Burgundy Hollow
3368 Church Road, Northampton, PA 18067 Horse Trials and/or Schooling
610-417-4231 Release of Liability
RELEASE MUST BE FILLED OUT COMPLETELY AND SIGNED IF YOU WISH TO PARTICIPATE IN THIS ACTIVITY
Date of Show and/or Schooling: ___________________
I agree that my participation in the Burgundy Hollow Schooling Horse Trial is subject to the conditions in this release.
I agree to wear protective headgear when riding.
I agree to wear protective headgear passing or surpassing the ASTM/SEI standards with harness attached.
I agree to wear body-protecting vests that meet or exceed current USEF rules and approved medical armband when riding in cross-country
activity.
I understand that the sport of eventing is a high risk sport and that my participation in this activity may also involve participation in an
“equine activity” as defined by Pennsylvania laws and is wholly at my own risk. I understand that my participation involves all inherent
risks associated with the dangers and conditions which are an integral part of equine activities including, but not limited to, the propensity
of equines to behave in ways which may result in injury, harm or even death to humans or other animals around or near them; the
unpredictability of equine reaction to sounds, sudden movements, smells, and unfamiliar objects; persons or other animals; hazards related
to surface and subsurface conditions; collisions with other equines or objects; and the potential of a participant to act in a negligent or
unskilled manner which may contribute to injury to the participant or others, including failing or inability to maintain control over the
animal.
I agree, by participating in this activity, to assume responsibility for those risks, and I release and agree to hold harmless the activity
organizer, organizing committee, officials, their officers, agents, employees and the volunteers assisting in the conduct of this activity and
the owners of any property on which said activity is to be held, from all liability for negligence resulting in accidents, damage, injury or
illness to myself and to my property, including the horse(s) which I may ride and which may accompany me.
I understand and agree that the organizer of this activity has the right to cancel this activity; to refuse any entry or application; to require
and enforce the wearing of safety or other attire and the conduct of riders, horses, and visitors; and to prohibit, stop or control any action
during the activity deemed by the organizer to be improper or unsafe.
I agree that as a condition of and in consideration of acceptance of entry Burgundy Hollow Horse Trials may use or assign photographs,
videos, audios, cablecasts, or other likenesses of me and my horse taken during the course of the competition for the promotion, coverage or
benefit of the competition, sport, the USEA, or the farm. Those likenesses shall not be used to advertise a product and they may not be used
in such a way as to jeopardize amateur status. I hereby expressly and irrevocably waive and release any rights in connection with such use,
including any claim to compensation, invasion of privacy, right of publicity, or to misappropriation.
I assume the risk of equine activity pursuant to Pennsylvania law.
Participant’s Name (Please Print)______________________________________________
Address___________________________________________________________________
City_____________________________ State_______________ Zip_________________
Phone ___________________________ Email ____________________________________
Number of horses I will be riding during activity (if applicable)____________
Level now riding (Check one) Starter_____ Beginner Novice_____ Novice _____
Signature ______________________________________Date _________________
Signature of Parent (If Participant is under 18 Release must be signed by Parent or Legal Guardian,
not by trainer or instructor.) __________________________________________________________