E.P.O.N.A. Beach Ride Registration and Release Form

Use your keyboard to fill in each field; you can tab from field to field.

When done, print and sign the form and mail it, with a check made payable to E.P.O.N.A., to:

E.P.O.N.A., PO Box 315, Epping, NH  03042-0315 OR fax it to 603-679-5178.

If you can't view this form or aren't able to use it, CLICK HERE.

 

Full Name:      Is Rider Under 18? (Yes or NO)

 

Home Phone #:      E-Mail Address:

 

Street Address or PO Box:

 

City, State and Zip Code:

 

In case of an emergency, we should contact:

Name 1:      Phone #:

 

Name 2:      Phone #:

 

Please check one of the following:

Ride and Brunch ($25.00)     Walk and Brunch ($20.00)

Please note there is a $7.00 parking fee for the State of Massachusetts Parks & Recreation Department.

E.P.O.N.A. is a 501(c)(3) and therefore donations may be tax-deductible.  Consult your tax professional.

 


 

GENERAL LIABILITY RELEASE

 

This release of Liability is made and entered into on this ____ day of _________________, _______, by

 

and between between E.P.O.N.A./Wendellís Wish and ____________________________, hereinafter

 

referred to as the Rider; and if the Rider is a minor, the Riderís Parent or Guardian,

 

_________________________________.  In return for the use today, and on all future dates of the

 

property, facilities, and services of E.P.O.N.A., the Rider, his/her heirs, assigns, and legal

 

representatives, herby expressly agree to the following:

 

  1. Rider and or Guardian agrees to assume ANY AND ALL RISKS INVOLVED IN OR ARISING FROM RIDERíS USE OF OR PRESENCE UPON E.P.O.N.A. PROPERTY, EVENTS AND FACILITIES including without limitation but not limited to, the risks of death, bodily injury, property damage, falls, kicks, bites, collision with vehicles, horses, or stationary objects, fire or explosion, the unavailability of emergency medical care, or the negligence or deliberate act of another person.
  2. Rider or Guardian, agrees to hold E.P.O.N.A. and all itís volunteers, employees, board members, successors, assign, subsidiaries, franchises, affiliates, officers, directors and agents, completely harmless, and not liable and release them from all liability whatsoever, and AGREES NOT TO SUE them on account of or in connection with any claims, causes of action, injuries, damages, costs or expenses arising out of Riderís use of or presence upon E.P.O.N.A.ís property, events and facilities, including without limitation those based on death, bodily injury, property damage, including consequential damages, except if the damages are caused by direct, willful, and wanton negligence of E.P.O.N.A.
  3.  Rider or Guardian agrees to wave the protection afforded by any statute or law in any jurisdiction (e.g. Calif. Civil Code S 1542) whose purpose, substance, and/or effect is to provide that a general release shall not extend to claims, material or otherwise, which the person giving the release does not know or suspect to exist at the time of executing the release.
  4. Rider or Guardian agrees to indemnify and defend E.P.O.N.A. against, and hold it harmless from, any and all claims, causes of action, damages, judgments, costs or expenses, including attorneyís fees, which in any way arise from Riderís use of/or presence upon E.P.O.N.A.ís property, events and facilities.
  5. Rider or Guardian agrees to abide by all of the E.P.O.N.A. rules and regulations.
  6. Rider, if using his/her horse shall be free from infection, contagious or transmissible diseases. E.P.O.N.A. reserves the right to refuse the Riderís horse if not in proper health or is deemed dangerous or undesirable.  A current negative Coggins (within past 6 months) is required and will be enforced.
  7. All dogs must be on a leash.
  8. This contract is non-assignable and non transferable, and is made and entered into the State of New Hampshire, and shall be enforced and interpreted under the laws of New Hampshire. Should any clause be in conflict with State Law, that clause is null and void and the remainder of the contract valid.  When signed by all parties stated above, then this contract will be binding on all parties, subject to the above terms and conditions.

 

 

___________________________________          ________________________________________

 Rider's Signature                                            Signature of parent/guardian for under-18 rider

 

 

____________________________________________          _______________________________

                 E.P.O.N.A./Wendell's Wish Representative Signature            Today's Date

 

Must be postmarked by May 6 or received via fax by May 7.

CLICK HERE for the Sponsorship Form

1