Parent/Guardian Youth Intake: Equine Mentorship Program

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Parent/Guardian Name:
Address:

Health Conditions

Please describe any pertinent health conditions we should be aware of on the ranch or other facilities: (Asthma, Seizures, Heart Conditions, Allergies, Food Sensitivities, Mobility Issues, etc.)

About the Youth

Consent & Agreement

Consent & Agreement RADYR EQUINE PARTICIPATION AGREEMENT (the “Agreement”): READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. IT CONTAINS LEGAL CONSEQUENCES THAT WILL AFFECT YOUR LEGAL RIGHTS AND ELIMINATE YOUR ABILITY TO BRING FUTURE LEGAL ACTIONS. RELEASED PARTIES INCLUDE: Rising Above Daily Youth Ranch, its agents, owners, officers, volunteers, participants, employees, landlords and property owners and all other persons or entities acting in any capacity on their behalf (collectively referred to as “RADYR’S”). RELEASING PARTIES INCLUDE: The undersigned participant and minor(s) listed in the Agreement, participant's spouse, children, parents, guardians, heirs, next of kin, and any legal or personal representatives, executors, administrators, successors and assigns, or anyone else who might claim or sue on participant's behalf. AGREEMENT – READ BEFORE SIGNING IN CONSIDERATION OF RADYR’S SERVICES: I hereby agree to release and discharge RADYR on behalf of myself, my heirs, assigns, personal representatives, my estate and any other person listed in this Agreement (cumulatively “participant”, “I”, “myself”), and as follows: RELEASE OF LIABILITY, ASSUMPTION OF RISK, INSTRUCTION, JURISDICTION, VENUE: I understand that by my presence on RADYR’S, I may engage in activities or utilize the RADYR’S in a way that may involve inherent risks that are beyond the control of RADYR’S. RADYR has taken precautions to provide a safe setting, but I understand that the possibility of injury, death, or loss to persons is present. Activities may include but are not limited to, riding horses, grooming horses, physical activity, walking/running, general recreation, general use of grounds including its improvements, and other equine equipment. By signing below, I hereby give consent for the below-mentioned participants to use the grounds and activities. (2) I expressly agree and promise to accept and assume all the risks existing in RADYR’S activities, both known and unknown, whether caused or alleged to be caused by the negligent acts or omissions of RADYR. My participation in all RADYR’S activities is purely voluntary and I elect to participate despite the risks. (3) I agree to acknowledge all of the rules and regulations pertaining to any and all activities (equine or otherwise) occurring on or off of RADYR’S property. I agree to and Rising Above Daily Youth Ranch Parent/Guardian Youth Intake Form Rising Above Daily Youth Ranch Parent Youth Intake Form 2024 Page 4 I am responsible for wearing protective gear if appropriate for said activities to ensure my safety while engaging in same. (4) I understand the risks, conditions, and dangers inherent in all RADYR’S activities. I agree to assume any and all risks involved in my use of or presence upon RADYR’S property and facilities while engaging in any activity without limitation. These risks include, but are not limited to, death, bodily injury, property damage, falls, kicks, bites, unavailability of emergency medical care, the ordinary negligence of another person or RADYR’S, and the deliberate acts of another person. (5) I agree not to sue or initiate any legal action (whether in court or in arbitration) against RADYR’S or any present or future owners, officers, members, managers, agents, employees and representatives of RADYR’S, in connection with any claim which could have been or could be raised against any of them in any way connected with, arising out of, or relating to, personal injury or damage to the maximum extent permitted by law. (6) I certify that I have adequate insurance to cover any injury I may suffer while participating, or otherwise agree to bear the costs of such injury or damage myself. I further certify that I have no medical or physical conditions, which could interfere with my safety in this activity, or am otherwise willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition. It is recommended that I visit a physician to ensure that these physical activities do not pose an unacceptable health risk. (7) I understand that this Agreement is in addition to, and not in lieu of, Washington State laws and regulations. MISCELLANEOUS: (24) I agree these releases are binding upon me, the minor(s) below for whom I am contracting, my heirs, executors, administrators, legal representatives, and successors. (25) Should RADYR or anyone acting on its behalf be required to incur attorney’s fees and costs to enforce this Agreement, I agree to indemnify and hold them harmless for all such fees and costs. (26) I agree that the validity and enforceability of this Agreement will be governed by the substantive law of Washington, without regard to its conflict of law rules. (27) If a provision of this Agreement is determined to be unenforceable in any respect, the enforceability of the provision in any other respect and of the remaining provisions of this Agreement will not be impaired. (28) I agree that any action, suit, or proceeding arising out of the subject matter of this Agreement will be litigated in courts located in Clark County, Washington. I consent and submit to the jurisdiction of any local, state, or federal court located in Clark County, Washington. Not a contract of employment: I understand and agree that any activities or tasks performed by me are strictly voluntary and are not in any way subject to not give rise to an employment relationship. I agree to save and hold harmless and indemnify each and all the parties previously referred to in this document, including without limitation RADYR’S, from all liability, loss, cost, claim, or damage whatsoever that may be imposed upon said parties because of any failure, or defect in or the lack of the minor(‘s/s’) capacity, to act in accordance with this Agreement, and I release the RADYR’S and said parties on behalf of the minor(s) and the minor(‘s/s’) parents or legal guardian of said minor(s). (29) I have carefully read this consent form, have been allowed to ask questions, and fully Rising Above Daily Youth Ranch Parent/Guardian Youth Intake Form Rising Above Daily Youth Ranch Parent Youth Intake Form 2024 Page 5 understand its contents. No representations, statements, or inducements, oral or written, apart from this form, have been made, except for those made by me in RADYR’S participation agreement (which is incorporated herein by this reference). My agreement to the provisions in this form is voluntary. I agree my releases are binding upon me, the minor(s) below for whom I am contracting, my heirs, executors, administrators, legal representatives, and successors.

Photo/Image Consent

RADYR PHOTO RELEASE AGREEMENT PHOTO RELEASE: I hereby grant to RADYR’S the unrestricted and absolute, perpetual, worldwide right to reproduce, exhibit, display, perform, transmit, broadcast, distribute, modify, create derivatives, and otherwise use the photograph(s) of myself and any minor(s) identified below (the “photograph(s)”) for RADYR print and social media.
Please Check the Box Below to Allow Photo/Images of Your Child:

Medical Emergency Consent

In the event of a crisis or medical emergency, I give Rising Above Daily Youth Ranch permission to contact Emergency Services 911 (IN ADDITION to contacting guardians) intending to provide support and community resources to the youth in my care.
Please Check the Box Below to Attest to Your Medical Emergency Consent:
*In the event of a mental health crisis or abuse disclosure Rising Above Daily Youth Ranch staff and mentors are mandatory reporters, and will contact local authorities or crisis services as we see fit. *

Parent/Guardian Signature

For Signature Type Full Name Above.
For Signature Type Full Name Above.
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