PONY POWER THERAPIES, LLC
GENERAL WAIVER OF LIABILITY
I acknowledge the risks and potential for risks of horse activities. However, I feel that the possible benefits to my self, my son, my daughter, my ward are greater than the risk assumed. I hereby, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against Pony Power Therapies, Inc., its Board of directors, instructors, therapists, volunteers and/or employees for any and all injuries and/or losses I may sustain while participating in Pony Power Therapies, Inc. By checking below, I agree to the terms.
Attendee Information
First Name
Last Name
Date of Birth
Is the above person 18 or older?
Yes
No
Cell Phone
Email
Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Phone
Parent/Guardian Email
Are you a...
Volunteer
Participant
Parent/Guardian
Other
Attendee's Address
Address Line 1
Address Line 2
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
MH
GU
MP
PR
VI
Zip Code
I consent to and authorize the use and reproduction by Pony Power Therapies of any and all photographs and any other audio/visual materials taken of me for promotional material, educational activities, exhibitions or for any other use for the benefit of the program.
Yes
No
I have read and understand the above general waiver of liability. By clicking yes and signing below, I am agreeing to its terms.
Yes
I have read and understand the above assumption of risk, waiver of liability and release relating to COVID-19. By clicking yes and signing below, I am agreeing to its terms.
Yes
Date
Emergency Contact Information
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone