Join us for you or your group to volunteer and/or learn more about what we do at Shepherd Youth Ranch! After you submit this form then you will receive an email with a link to sign up for a specific date. Please check your spam mail to look for the email if you do not immediately receive it. Parents of youth under 18 will need to fill out this form.
See you at the Ranch!
Assumption of Risk and Responsibility Release of Liability & Consent for Treatment
North Carolina Horse Council Warning: "Under the North Carolina Law, an Equine Activyt Sponsor or Equine Professional is not liable for an injury to, or the death of, a participant in equine activites resulting exclusively from the inhearent risks of equine activies" Chaper 99E, North Carolina General Statues
Acknowledgement of Risks:
I hearby request that the participants named above be accepted onto the property of 3017 Brassfield Road, Creedmoor, NC and/or into the equine assisted therapy program, horsemanship skill building programs, volunteering, other on/off campus skill building programs operated by Shepherd Youth Ranch herein referred to as SYR and Ashley Boswell. I acknowledge that a SYR staff or volunteer member has fully explained to me the scope of the equine assisted therapy and/or horsemanship skill building activities, including the potential for injury which can occur from riding horses, working with horses or being involved in the therapeutic/learning activities that included horses. Because of the potential benefits of the equine-assisted programs, I hereby waive any claim, which the client or I may have against Ashley Boswell, SYR Board of Directors, or any SYR staff or volunteer arising out of injury the client may sustain while on the property and/or involved in the equine program. I further understand that under North Carolina General Satues law Chapter 99E, an equine professional is not liable for an injury to or the dath of, a participant in equine activities resulting from the inhearent risks of equine activities. The undersigned assumes the unavoidable risks inherent in all horse-related activites and non horse related activies resulting from the inherent risks of equine activities. The undersigned assumes the unavoidable risks inherent in all horse-related activities and non horse related activites, including but not limited to bodily injury and physical harm to rider, participant and spectator, hazards from uneven or unstable ground or road surfaces, trees, branches, rocks, stones, gravel, mud, water, and/or vehicles, other horse and riders, equipment failure, my ability to control or direct the animal, and the speed at whcih I proceed can pose a dangerous risk to my safety, that movement, noise , and contact with objects might frighten or cause an animal to move unpredictable and with force; that I may suffer accidents or illnesses in remote pleaces where there are no available medical facilities and that no warranty of any kind, express or implied, is being made as to the habits, disposition, suitability, nature, or physical condition of any animal. I realize that personal property may be lost or damaged, that certain foreseeable and unforeseeable events can contribute to the impredictability of the risks, dangers and hazards of the acivity, that wearing a helmet while riding a horse is a basic precaution and that I should ask about other potential risks, dangers and hazards recommended precautions and procedures.
Express Assumption of Risk and Responsibility:
In recognition of the inherent risks of the activity, which I and any minor children for which I am responsible, will engage in, including approaching, handling, mounting, riding and dismounting an animal, I confirm that I am (we are) physically and mentally capable of participating in the activity and using the equipment. I/We participate willingly and voluntarily and I assume full responsibility for personal injury, accidents or illness, including death. I assume all responsibility for damage to or loss of personal property as the result of any major accident that may occur.
I assume the risk(s) or personal injury, accidents and/or illness, including but not limited to sprains, torn ligaments and/or muscles; fractured or broken bones; eye damage, cuts, wounds, scrapes, abrasions, and or neck, head, and/or contusions; dehydration, oxygen shortage (anoxia), exposture and/or altitude sickness, head, neck, and/or spinal injuries; animal bite(s) or attack, inect bites, allergic reaction; shock, paralysis, and/or death, and acknowlege that if, during the activity, I/we experience fatigue, chill and/or dizziness, my/our reaction time may be diminished and the risk of accident, increased.
Covenant of Good Faith:
I recognize that SYR, SYR Board of Directors, Ashley Boswell, SYR Equine Specialists and Volunteers as provider of goods, and/or services, will operate under a covenant of good faith and fair dealing, but may find it necessary to terminate an activity due to forces of nautre, medical necessities or other problems; and/or refuse or terminate, that participation of any person you judge to be incapable of meeting the rigors or requirements of participating in the activity. I accept your right to take such actions for the safety of myself and/or other participants.
I hereby authorize any medical treatment deemed necessary in the event of any injury while participating in the activity. I either have appropriate insurance or, in it's absence, agree to pay all costs of rescue and/or medical services that may be incurred on my/our behalf.
In consideration of service or property provided, I, for myself and my minor children for which I am a parent, legal guardian or otherwise responsible, any heirs, personal representatives or assigns, do hereby release SYR INC., Ashley Boswell, SYR Board of Directors and other contract staff and volunteers both of their principles, directors, officers, agents emplyees and volunteers, family members, and each and every land owner, municipal and/or government agency upon whose property an activity is conducted, from all liability and waive any claim for damage arising from any cause whatsoever.
I (We) have read the forgoing acknowledgement of risk, assumption of risk and liability and release of liability. I understand that by signing this document I a may be waiving valuable legal rights.
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