[{"type":"header","label":"Rider registation, waiver and disclaimer form.","className":"waiver-header-element"},{"type":"paragraph","label":"Please read and fill out this form very carefully this is a legally binding document. The information you give and your acceptance of all the terms and conditions herein, may be used by us in event of an accident or dispute and the information you give will be used to form the basis of our service to you.

THIS IS A LEGALLY BINDING DOCUMENT.

","className":"waiver-legal-element"},{"type":"header","label":"Personal information"},{"type":"text","required":true,"label":"1.1 Name (participant)","className":"form-control","name":"text-1700654757558"},{"type":"text","required":false,"label":"1.2 Name (Parent if participant under 18 years)","className":"form-control","name":"text-1700654918455"},{"type":"text","required":true,"label":"Address","className":"form-control","name":"text-1700655024055"},{"type":"text","required":true,"label":"Email Address","className":"form-control","name":"text-1700655071522"},{"type":"text","required":true,"label":"Contact phone number","className":"form-control","name":"text-1700655154121"},{"type":"text","required":true,"label":"Participant date of birth","className":"form-control","name":"text-1700655183971"},{"type":"radio-group","required":true,"label":"For equine welfare and operational reasons Bergin Equine has a maximum ridden weight limit of 85kg (187 lb 4oz). Riders must be below this limit to participate in ridden activities. Please tick the appropriate box below","name":"radio-group-1717047395000","other":false,"values":[{"label":"Yes I am less than 85kg.","value":"option-1"},{"label":"No I am not less than 85kg, however I am not participating in ridden activities.","value":"option-2"}]},{"type":"radio-group","required":true,"label":"Have you, or the participant you are signing for, ever suffered a serious injury or discomfort while participating in equestrian activities or been advised not to participate? \n","name":"radio-group-1700655378204","other":false,"values":[{"label":"Yes","value":"option-1"},{"label":"No","value":"option-2"}]},{"type":"textarea","required":true,"label":"Do you have any learning difficulties that we need to be aware of? Please give details. (Mark not applicable if required) ","className":"form-control","name":"textarea-1700655410671","rows":1},{"type":"textarea","required":true,"label":"Do you have any allergies (including medical allergies) we need to be aware of? Please give details. (Mark not applicable if required)","className":"form-control","name":"textarea-1700656932777"},{"type":"textarea","required":true,"label":"Please detail any disability, medical or behavioural conditions that may affect your (or the participants) ability to ride or follow instructions. This may include but not limited to any back problems and any condition, which can affect balance or cause blackouts/loss of consciousness/seizures etc. (Mark not applicable if required)","className":"form-control","name":"textarea-1700656820360"},{"type":"textarea","required":true,"label":"Is there any other relavant information of any kind that you need to share with us?","className":"form-control","name":"textarea-1700658078492"},{"type":"header","label":"Details of riding experience."},{"type":"radio-group","required":true,"label":"I consider myself (or the person riding for who I am signing on behalf as a minor) to be a:","description":"Please select one only.","name":"radio-group-1700655588385","other":false,"values":[{"label":"Beginner","value":"option-1"},{"label":"Novice","value":"option-2"},{"label":"Intermidate","value":"option-3"},{"label":"Advanced Intermediate","value":"option-4"},{"label":"Advanced","value":"option-5"}]},{"type":"radio-group","required":true,"label":"How many times have you (or the person riding for who I am signing on behalf as a minor) ridden in the last 12 months?","description":"Please select one only.","name":"radio-group-1700655687567","other":false,"values":[{"label":"0 - 10","value":"option-1"},{"label":"10 - 20","value":"option-2"},{"label":"20 - 40","value":"option-3"},{"label":"40 - 60","value":"option-4"},{"label":"60 - 100","value":"option-5"},{"label":"100 +","value":"option-6"}]},{"type":"checkbox-group","required":false,"label":"I (or the person riding for who I am signing on behalf as a minor) believe I am capable of:\n","description":"Please select all that apply.","toggle":false,"name":"checkbox-group-1700655843768","other":false,"values":[{"label":"Riding at walk","value":"option-1"},{"label":"Riding at trot","value":"option-2"},{"label":"Riding at canter","value":"option-3"},{"label":"Riding over small jumps ","value":"option-4"},{"label":"Riding over jumps up to 50cm","value":"option-5"},{"label":"Riding over jumps up to 70cm","value":"option-6"},{"label":"Riding over jumps over 80cm","value":"option-7"}]},{"type":"header","label":"The Horse Riders’ Code Of Conduct"},{"type":"paragraph","label":"1. I (and the participant) understand that riding at any standard has inherent risk and that all horses may react unpredictably on occasions.

2. I (and the participant) may fall off and could be injured. I accept that risk. I (and the participant) understand that my horse (owners horse) may become injured or may injure others. I accept that risk.

3. I (and the participant) understand that instructions are given for my safety and agree to follow instructions.

4. I (and the participant) reserve the right not to ride. I (and the participant) understand that wearing an appropriate riding hat and body protector may reduce the severity of an injury should an accident happen and agree that I will always wear an approved riding helmet whilst riding and leading horses during equestrian activities.

5. I (and the participant) understand it is my choice whether or not I wear a body protector. I (and the participant) understand that decisions are based on information I give and I agree to always be honest and volunteer information about: my abilities and riding experience any previous riding accidents any medical condition(s) which may affect my ability to ride or follow instructions.

6. I (and the participant) understand that children are at particular risk around horses and agree that I will keep children that I am responsible for, under close supervision.

7. I (and the participant) understand that my request to ride may be refused for safety or operational reasons.

8. I (and the participant) agree to be bound by all the policies set out including but not limited to the cancellation policy etc. which are all subject to change without notice.

9. I (and the participant) understand that cross country/competing carries enhanced risk over and above general riding and agree that if I (and the participant) choose to participate in any cross country/competition or event, it is up to me to ensure that I have the experience and ability to ride the course including any jumps which form part of it. If I am in any doubt, I (and the participant) will use my judgment and experience and not enter.

"},{"type":"header","label":"Waiver and Disclaimer Form (This is legally binding)"},{"type":"paragraph","label":"1.1 I confirm that to the best of my knowledge all the above information is correct.

1.2 I have read and agree the “Horse riders code of conduct”

1.3 I understand that riding at any standard has an inherent risk that I may fall off and could be injured. I accept that risk and agree that the coach, land owner, tenant or organiser and any other associated person will not be liable for any injury or damage to property.

1.4 Where I am signing on behalf of a minor I have explained the “Riders code of conduct” to my child and we both accept the risk and agree that the coach, land owner, tenant or organiser and any other associated person will not be liable for any injury or damage to property.

1.5 I understand that information I have given will be held in accordance with the Data protection regulations but may also be made available to insurers and other concerned parties in event of any injury or accident.

2.1 I (and on behalf of my minor child/ward if applicable) of (address) ACKNOWLEDGE THAT HORSES ARE DANGEROUS ANIMALS AND ANY INTERACTION WITH A HORSE CONSTITUTES A HIGH LEVEL OF RISK; for example (and not limitation) falls, kicks, bites, crushes which may result in serious or even fatal injury. This risk can limited by provision of safety equipment such as an appropriate helmet and body protector. Every client should wear safety equipment, suitable (appropriate); footwear, gloves and clothing (nothing loose or flappy).

2.2 I HEREBY ASSUME ALL THE RISKS OF PARTICIPATING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise on the part of the persons or entities being released (named below in 5.2) from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

3.1 I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health related reasons or problems which preclude my participation in this activity or event.

4.1 I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organisers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event.

5.1 In consideration of my application and permitting me to participate in this activity/ event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

5.2 I WAIVE, RELEASE, AND DISCHARGE from any and all liability the entities or persons released, for my death, disability, personal injury, property damage, property theft, injuries or damage to horses ponies or other animals in my custody or control or actions of any kind which may hereafter occur to me including my traveling to and from this event/activity, THE FOLLOWING ENTITIES OR PERSONS: Brendan Bergin, Michelle Callan, Bergin Equine and any employee, assistant, relative or agent, the land owner, tenant or organiser and any other associated persons.

5.3 I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO TAKE LEGAL ACTION AGAINST the entities or persons mentioned in this paragraph (Above 5.2) from any and all liabilities or claims made as a result of participation in this activity or event, regardless of cause.

6.1 I acknowledge that the entities named above (in 5.2) are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf the entities named above (in 5.2).

7.1 I acknowledge that this activity or event may involve a test of a person’s physical and mental limits and may carry with it the potential for death, serious injury, and property loss/damage or injuries to horses/ponies or other animals in my custody or control. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to participants, but are also present for volunteers.

8.1 I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity or event. I understand that at this event or related activities, I (or the participant) may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organisers, and assigns. The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

"},{"type":"checkbox-group","required":true,"label":"Electronic signature consent & Acceptance.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL AND AGREE TO ALL TERMS.

*PARENT/GUARDIAN WAIVER FOR MINORS (if under 18 years old, parent or guardian must also sign). The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.\n

","className":"waiver-accept-element","name":"checkbox-group-1700654458972","values":[{"label":"CLICK HERE TO ACCEPT ALL TERMS","value":"option-1"}]},{"type":"signature","required":true,"label":"Signature","className":"waiver-signature-element","name":"signature-1700654458977"}]

Bergin Equine

Filteren op uw vaardigheidsniveau