#1 Volunteer Opportunities [System-Generated]

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Phone Number *

Is Participant 18 or Older? *

For Minor Participants (Under 18):

Skip to next section if Participant is Over 18

Minor Participant Name

Parent / Legal Guardian Full Name

Parent / Legal Guardian Phone Number

Parent / Legal Guardian Email

Waiver Acknowledgements

IMAGE/MEDIA RELEASE CONSENT: I expressly agree that the Released Parties may take and use visual/audio images of me, which include but are not limited to, recordings, photographs, digital images, drawings, video recordings, voice, sound, or audio clips, or accompanying written descriptions (the “Images”). I agree that the Released Parties own the Images and all rights related thereto, including any royalties, proceeds or any benefits derived therefrom and that I am not entitled to any compensation relating to the Images. The Released Parties may use the Images in any matter or media without notifying me, including but not limited to use in web sites, publications, promotions, broadcasts, advertisements, posters, presentations, exhibits and videos. I further grant to the Released Parties, without time restrictions, full rights to republish or rebroadcast the Images. I waive any right to inspect or approve the finished Images or any printed or electronic matter that may be used therewith. I release the Released Parties from all claims, damages and liability in connection with the taking or use of the Images or printed material used with the Images. *

Yes

Yes/No (if client is a minor; parent or guardian must check one)

By agreeing to this document, I acknowledge that Equellness Center may conduct a background check as part of the volunteer process. Do you agree with this condition? *

Yes

Saying no doesn’t automatically disqualify you from becoming a possible Equellness Center Volunteer.

VOLUNTEER LIABILITY WAIVER AND RELEASE *

VOLUNTEER LIABILITY WAIVER AND RELEASE
READ THIS AGREEMENT CAREFULLY BEFORE SIGNING IT. YOUR SIGNATURE INDICATES YOU UNDERSTAND IT AND AGREE TO ITS TERMS. BY SIGNING THIS AGREEMENT, YOU (AND/OR YOUR CHILD, IF APPLICABLE) ARE VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR RECOVER DAMAGES IN CASE OF INJURY, DEATH OR PROPERTY DAMAGES, FOR ANY REASON,INCLUDING BUT NOT LIMITED TO, NEGLIGENCE

I hereby enter into this Liability Waiver and Release (“Release”) as of the date of my electronic signature, in favor of Equellness Center, Bergmann Equine, Park City Horse Experience, and each of their current and former owners, trustees, officers, directors, parents, shareholders, subsidiaries, affiliates, branches, members, sponsors, employees, contractors, volunteers, attorneys, agents, and the heirs, executors, administrators, receivers, successors, property owners, and assigns (collectively, the “Released Parties”).

The activities or work organized and offered by Equellness Center (in conjunction with Park City Equine Experience and other wellness providers) at the Bergmann Equine Ranch may include, but are not limited to:

the handling and riding of, and other interactions with, horses;
interactions with dogs, cats, cows, goats and potentially wild animals;
activities related to the use of tools and other equipment and machinery, such as tractors;
activities conducted in and around a running stream and other bodies of water; and ∙ other activities involving the day-to-day operations of a working ranch and wellness activities.

I wish to participate in these activities, and any other activities that third parties may organize and offer at the Equellness Center with the consent of the Equellness Center (collectively, the “Activities”) either as a volunteer for the Equellness Center or as a voluntary participant in the Activities.

By signing this Release, I certify that I have no physical condition that would present a risk of injury or death through my participation in the Activities, and I agree and acknowledge that my participation is completely voluntary and without compensation or remuneration from the Released Parties. I shall have the right to cease participation in the Activities at any time, even though such cessation may not result in a refund or discount related to any of the Activities.
In order to serve as a volunteer for the Equellness Center and/or participate in the Activities, I hereby voluntarily, with full knowledge of the possible dangers and inherent risks associated with the Activities and without duress, execute this Release under the terms set forth below.

1. Acknowledgement of Risks
I understand the fact that there is an inherent danger in any activity, such as the Activities, which involves physical exertion, risk taking, contact with animals or that may take place in rugged terrain with limited protection from the elements; that natural hazards do exist; that although the Activities may not be strenuous, injuries or medical complications may occur; that certain foreseeable and unforeseeable events unique to each individual Activity may contribute and that I should ask about other potential hazards and recommended precautions. I understand that such risks cannot be eliminated without jeopardizing the essential qualities of the Activity. Although precautions are taken to provide proper organization, supervision, instruction, and equipment for my participation in the Activities, there can be no guarantee about absolute safety against injury and unforeseeable accidents. I understand that no horse is a completely “safe” horse. I understand that horses are dangerous and often unpredictable animals and any activity undertaken around or near horses can lead to bodily injury or death, even if proper care is taken. Some, but not all, of the inherent risks associated with equine activities are:

possible equipment failures and/or malfunctions (i.e. saddles or bridles may loosen or break which may cause the participant to be jolted or fall);
the propensity of a horse to behave in dangerous ways that may result in injury to the participant regardless of the equine’s previous training and past performance;
the inability to predict a horse’s reaction to sound, movements, unfamiliar environment, objects, persons or animals;
natural hazards including but not limited to surface or subsurface conditions; and ∙ propensity for a horse to run, buck, bite, kick, shy, stumble, rear, trample, fall, make unpredictable movements, spook, jump, butt, step on a person’s feet, push or shove without warning or apparent cause.

I understand and agree that the Equellness Center does not make any representations about the advisability of my participation in the Activities or any guidance provided during participation in the Activity. I understand that my safety may depend largely upon my ability to carry out instructions in accordance with guidelines, and I agree that if I choose to participate in any Activity I will follow instructions and guidelines given to me for the Activity and will conduct myself in a manner that is safe for those and myself around me.
I am also aware of the contagious nature of bacterial and viral illnesses including COVID-19 and the risk that I may be exposed to or contract COVID-19 or another illness by participating in the Activities, which may result in serious illness, personal injury, disability, death, and/or property damage.

2. Assumption of Risks
In recognition of the inherent risks of the Activities, I confirm that I am physically and mentally capable of participation in the Activities and/or using equipment, that my participation is willingly and voluntarily, and I assume full responsibility for personal injury, accidents, or illnesses, including death. I also assume responsibility for damage or loss of personal property as the result of any accident that may occur. I assume the risk(s) of personal injury of any kind or nature.

3. Release and Waiver
I, on behalf of myself, my family, estate, heirs and assigns, hereby release and forever discharge and hold harmless the Released Parties from any and all losses, damages, liability, claims, and demands of whatever kind or nature, either in law or in equity, which I may have against any of the Released Parties which may arise as a result of my participation in the Activities, whether or not arising due to the negligence of the Equellness Center, any other Released Party, myself or any third party. I further agree not to bring any claims or actions against any of the Released Parties based upon or arising from my participation in the Activities.
I also understand that the Equellness Center and the other Released Parties do not assume any responsibility for, and have no obligation to provide, financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of any injury or illness I may sustain by participating in the Activities. I further hereby give permission to the Equellness Center or any of its agents to secure from any licensed hospital, physician, or medical personnel any treatment considered necessary for my immediate care. I hereby consent to receive medical treatment deemed necessary if I am injured or require medical attention during my participation in the Activities. I understand and agree that I am solely responsible for all costs related to such medical treatment and any related medical transportation and/or evacuation. I hereby release, forever discharge, and hold harmless the Released Parties from any claim based on such treatment or other medical services. I understand that the Equellness Center does not provide medical advice or diagnosis and is not intended as a substitute for a licensed physician.

4. Insurance
I hereby certify that I have adequate insurance to cover any injuries or damages I may cause or suffer while participating in the Activities, or else I agree to bear the costs of such injury or damage myself. I expressly waive any right or claim to any insurance proceeds received by any of the Released Parties in connection with the Activities.

5. Indemnification
I agree to release, indemnify and hold the Released Parties harmless from any loss, damage, liability, claim or demand of any kind that may be sustained by a third party or myself, or to any property belonging to a third party or myself, including any costs or attorneys’ fees, that may arise as a result of my acts or omissions while participating the Activities. Should the Equellness Center, any Released Party or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this Release, I agree to indemnify and hold them harmless for all such fees and costs.

6. Helmets
ALL RIDERS MUST WEAR A PROTECTIVE EQUESTRIAN HELMET. Participants are welcome to bring their own ASTM/FEI certified helmet. If participants do not have access to a helmet, one will be provided.
Those 12 years of age and under must also wear a helmet when around the horses; this includes being on the horse and on the ground around the horse.

7. Miscellaneous
This Release constitutes the sole and entire agreement of the Equellness Center and participant with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. This Release shall remain in full force and effect so long as I am participating in any Activities. This Release is intended to be as broad and inclusive as permitted by the laws of the State of Utah. I agree that, if any term or clause of this Release shall be deemed illegal, invalid or unenforceable, then the remainder of this Release shall not be affected thereby. I have freely and voluntarily entered into this Release and signed my name below to express my acceptance of these terms and conditions of participation in the Activities. By signing this Release, I certify that I have had the opportunity to read this Release and consult with an attorney of my choice regarding the meaning of this Release and that I fully understand all of its provisions and their implications.

8. Governing Law; Waiver of Jury Trial
This Release shall be governed by the laws of the State of Utah. Any controversy or claim, whether in tort, contract or otherwise, arising out of or relating to the relationship between myself and the Released Parties shall be brought in the courts of the State of Utah. I waive any objection I may now or hereafter have to personal jurisdiction, venue or to convenience of forum, agree that all claims in respect of the proceeding or action shall be heard and determined only in any such courts, and agree not to bring any proceeding or action arising out of or relating to this Release in any other courts. I irrevocably waive, to the fullest extent permitted by applicable law, any right I may have to a trial by jury in respect of any suit, action or other proceeding arising out of this Release.

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I represent that I am of legal age and am freely signing this Release. I have carefully read, fully understood, and agree to all of the terms in this Release and I am voluntarily waiving substantial legal rights that I may have against the Equellness Center.

*All adults must fill out separate forms
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Type your Full Legal Name in the space below to agree.

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