FIRE STORM 
EQUESTRIAN CENTER
 1-661-268-1715              1-661-268-8440 Fax

FIRE STORM EQUESTRIAN CENTER      (Click here for printable version)

ASSUMPTION OF RISK, RELEASE AGREEMENT

I, the undersigned, on behalf of myself and my personal representative, heirs, guardians, guest, next of kin, spouse, and assigns, and on behalf of my minor child (ren) named below, DO HEREBY AGREE THAT:

(a) In consideration of the use of the premises of Fire Storm Equestrian Center, the undersigned recognized and agrees that participation in horse sports and horse related activities is DANGEROUS AND HAZARDOUS, AND MAY EVEN LEAD TO INJURY, PERMANENT INJURY, OR DEATH.

(b) I RELEASE AND FOREVER DISCHARGE FIRE STORM EQUESTRIAN CENTER, and its officers, directors, partners, investors, shareholders, agents, owners, employees, sub contractor, all land owners, renters, lessees, volunteers, trainers, event organizers, adjoining land owners, owners of any equipment/vehicles/trucks on property, judges, event organizers, vendors, food suppliers, food preparers, food servers, trainers, coaches, Coulombe/Sarvis/Gros family members, West Coast Water Tenders, inc., High Torque Marine, inc., any and all affiliate Trusts and all instructors and other persons acting on their behalf or in concert with them ( hereinafter the ~RELEASED PARTIES~) FROM ANY AND ALL CLAIMS, LIABILITIES, AND LOSSES BASED ON NEGLIGENCE PASSIVE OR ACTIVE, STRICT LIABILITY, FAILURE TO WARN OR OTHERWISE, AND AGREE NOT TO SUE, AGREES TO HOLD HARMLESS, REGARDLESS OF NEGLIGENT ACTS OF OR OMISSIONS, OR BRING TO MEDIATION the RELEASED PARTIES for injury, permanent injury, death, losses of any kind, damages to me (or my child-ren) my horse(s), or any other person, animal or property, directly or indirectly arising out of or resulting from the riding, handling, participating, watching, helping, training, instructing, carting, transportation or stabling of any horse (whether owned, rented, leased, borrowed, RELEASED PARTIES, or otherwise) on the premises of the RELEASED PARTIES, or in any adjacent areas where horses are stabled, ridden, boarded or handled. I promise to indemnify and hold RELEASED PARTIES harmless from any loss, injury, damage, claim, judgment or expense that RELEASED PARTIES may arising out of my (and my child-ren) activities or presence on such or in such areas.

(c) PARTICIPATING IN, OBSERVING, OR BEING IN THE PRESENCE OF ACTIVITIES INVOLVING HORSES, ponies, animals of any kind, including riding, vaulting, handling, carting, training, instructing, loading, transporting, boarding, stabling or care (whether or not under the supervision of parents, instructors, RELEASED PARTIES, coaches or trainers), POSES DANGER AND RISK OF INJURY OR DEATH to people, animals, property and livestock. I acknowledge that: (1) worn defective equipment, and other horses, spectators and riders are hazardous to me (and my child-ren), my horse(s), and property; (2) I have and will continue to inspect the horse(s), riders, saddles, bridles, barriers, gates or lack thereof, lighting or lack thereof, ranch vehicles and weather condition; (3) the facilities, vehicles, trucks, horse(s) and equipment of RELEASED PARTIES are NOT believed to be free of defects or deterioration; (4) the horses, riders, handlers, RELEASED PARTIES and spectators may not be trained, knowledgeable or experienced; (5) instructors, coaches and trainers may NOT assess correctly the skills, experience of ability of horse and rider, or the difficulty or danger of any jump course, riding exercises or activities; (6) the facilities have natural and unnatural hazards which include but are not limited to ditches, canyons, glass, wire, metal, dirt roads, cliffs, Highway, asphalt, jumps, structures and other obstacles, hills, rock's, water, ponds, gopher holes, uneven ground or footing, snakes, debris, low hanging trees, falling branches, farm equipment, water trucks, trailers, wood fencing and wild and domesticated animals of all kinds; (7) horses present in the area may have been known to bite, buck, rear, kick, bolt, become uncontrollable or misbehave without warning; and (8) the existence of dogs, birds, insects wild and domestic animals of all kinds, trucks, tractors, motorcycles, off road vehicles, farm equipment, cars, helicopters, planes, sprinklers, sirens, loud speakers, announcers, music, phones ringing, other vehicles, and noises in and around the area may pose increases hazards. (9) agree that as a condition of and in consideration of acceptance of entry, they authorize the RELEASED PARTIES to market, transfer, assign, or otherwise make use of any photographs, likenesses, films, broadcasts, cable casts, audio tapes, or video tapes taken of the horse(s) and the participant(s) while on the grounds, incident to, or in transit between the stabling facility and the event site, in any way they see fit or promotion, coverage, or benefit of the event, or service, and hereby expressly and irrevocable waive and release any rights in connection with sues use, including any claim to invasion of privacy, right of [publicity, or to misappropriation, Nevertheless, I VOLUNTARILY ELECT TO ASSUME ALL RISKS, ASSUMPTION OF RISK AND AGREEMENT TO HOLD HARMLESS, connected with the entry of me (and my child -ren) and/or my hors(s) and/or my property onto the premises of the RELEASED PARTIES and adjacent areas, and with participating activities involving horses.

(d) If any portion of this agreement is held invalid, the balance shall continue in full force and effect . I have not signed this agreement in reliance of any representation or inducement of the RELEASED PARTIES.

e) NO riders under the age of 18 shall handle or ride the stallions, no riding bareback, no riding double, no running of participants and/or horses unless in designated area, dogs allowed if on leash at all times on RELEASED PARTIES property. Coach/Instructor shall be present at all times while their rider is on RELEASED PARTIES property. I represent that my horse(s) and I (and my child-ren) have the requisite training, coaching, and ability to safely complete in this competition. I agree (and my child-ren) to wear protective headgear when mounted or riding. When jumping, I agree (and my child-ren) to wear protective head gear and passing or surpassing the ASTM/SEI standards with harness attached that meet standards currently imposed by the U.S. Equestrian Rules for Event. I understand that the USEA mandates that all riders participating in cross-country / jumping activity measures needed for handling horses. Arm bands can be purchased from the USEA web site or by calling them.

*Horse Trainer = adult person assuming all legal liability for care of riders horse while it is on RELEASED PARTIES property. *Rider Coach/instructor = person who gives verbal instructions to the rider while he/she in on RELEASED PARTIES property. I HAVE READ THIS DOCUMENT AND I UNDERSTAND IT INCLUDES A RELEASE OF CLAIM FOR INJURY, PERMANENT INJURY OR DEATH TO ME (OR MY CHILD-REN) AND FOR LOSS, THEFT, OR DEATH OF, OR INJURY OR DAMAGE TO MY HORSE(S) OR OTHER PROPERTY. THE UNDERSIGNED RECOGNIZES AND AGREES THAT BY EXECUTING THIS ASSUMPTION OF RISK, RELEASE OD LIABILITY AND INDEMNIFICATION AGREEMENT, HE OR SHE IS WAIVING AND RELEASING VALUABLE LEGAL RIGHTS. ALL SIGNATURES BELOW ARE MANDATORY WHEN ENTERING RELEASED PARTIES PROPERTY. OWNERS OF HORSES, RIDERS, TRAINERS, COACHES, INSTRUCTORS, SPECTATORS, PARENTS ARE TO CARRY THEIR OWN INSURANCES TO COVER ALL OF THE ABOVE MENTIONED DANGER AND LOSSES.

1) Rider signature _________________________________________________Print Name________________________________________ (rider must be 18 or older to sign this release without a parents consent)

2) Owner of Horse signature_________________________________________Print Name_________________________________________

3) Trainer of Horse ________________________________________________Print Name_________________________________________

4) Coach / Instructor of rider signature ________________________________ Print Name ________________________________________

5) Parent./Guardian _______________________________________________Print Name ________________________________________ DATE ______________________ ALL SIGNATURES MUST BE PRESENT OR ENTRY WILL NOT BE ACCEPTED.

                               All Jumper/Derby Schooling Show  (JULY 18th)

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DATE OF SHOW:_________________________ NO#____________

NAME OF RIDER:___________________________________________________________AGE:______________

ADDRESS:__________________________________________________________________________________

___________________________________________________________________________________

PHONE #__________________________CELL#_________________________FAX#_______________________

E-MAIL:_______________________________________________EMERGENCY#_________________________

HORSE NAME:_______________________________________________BREED:__________________________

AGE:________________COLOR:________________________________SEX:_____________________________

OWNER:_______________________________________SIGNATURE:___________________________________


CLASSES ENTERED (PLEASE CIRCLE) 1    2     3     4     5    6    7    8    9    10    11    12    13    14    15    16

CLASSES 1 & 2                                                    ($20.00 each class) x______classes  $________

CLASSES 3-8 & 10 & 12-13                  ($14.00 each class) x ______classes $________

Mini Prix Classes 9 & 11                      ($16.00 each class) x______classes  $________

Day End High Point (circle group 1,8,9 - 2,10,11 - 3,4,5 - 6,7,8 - 9,10,11 add $10.00)     $________


LATE FEE: (All entries must be post marked or faxed or 10 days prior to show date or
entry will be considered late. A $15.00 late fee to be added if after that date)
                                                                                                    $________

GRAND TOTAL:                                                                                                    $_______

 ALL RIDERS MUST WEAR REGULATION HELMETS WHEN MOUNTED. IN ADDITION CROSS COUNTRY RIDERS MUST WEAR MEDICAL ARM BAND, AND REGULATION BODY PROTECTION VEST. THE UNDERSIGNED HAS READ, UNDERSTANDS AND AGREES TO THE ASSUMPTION OF RISK AND RELEASE AGREEMENT. THE UNDERSIGNED RECOGNIZED AND AGREES THAT PARTICIPATING IN HORSE SPORTS, RANCHING, SCHOOLING, FARMING, AND HORSE RELATED ACTIVITIES IS DANGEROUS AND HAZARDOUS, AND MAY EVEN LEAD TO PERMANENT INJURY OR DEATH. THE UNDERSIGNED VOLUNTARILY ELECTS TO ASSUME ALL RISK, ASSUMPTION OF RISK AND AGREES TO HOLD RELEASED PARTIES HARMLESS. (READ SEPARATE ASSUMPTION OF RISK, RELEASE AGREEMENT COMPLETELY PRIOR TO SIGNING)

 

RIDERS SIGNATURE:________________________________________________DATE:____________________



PARENT / GUARDIAN SIGNATURE:______________________________________DATE:____________________

(must be signed if rider is under 18 years of age)

Please send completed form and entry fee to:

FSEC c/o LIA COULOMBE, 11306 Sierra Hwy, Agua Dulce, Ca 91390 (PHONE 661-268-1715) or Fax 661-268-8440

 

MAKE CHECK PAYABLE TO : COULOMBE

 

 

DRESSAGE - UNDER The STARS -
         June 27th, 2009 start at 4 pm
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DATE_________________________________

RIDER NAME_______________________________HORSE NAME_____________________________

ADDRESS__________________________________________________________________________________

PHONE#_______________________CELL_______________________E-MAIL____________________


TESTS ENTERED__________________________________,________________________________,

_____________________________________,__________________________________


TOTAL FEE PER HORSE AND RIDE PER TEST ENTERED
                                                 First Test                   $30.00 X_____1_______TEST =   $       30.00
                                                Additional tests        $15.00 X_____________TESTS=  $______________
    
                                                                                                                          TOTAL DUE   $______________                                                         


ALL RIDERS MUST WEAR REGULATION HELMETS WHEN MOUNTED. IN ADDITION CROSS COUNTRY RIDERS MUST WEAR MEDICAL ARM BAND, AND REGULATION BODY PROTECTION VEST. THE UNDERSIGNED HAS READ, UNDERSTANDS AND AGREES TO THE ASSUMPTION OF RISK AND RELEASE AGREEMENT. THE UNDERSIGNED RECOGNIZED AND AGREES THAT PARTICIPATING IN HORSE SPORTS, RANCHING, SCHOOLING, FARMING, AND HORSE RELATED ACTIVITIES IS DANGEROUS AND HAZARDOUS, AND MAY EVEN LEAD TO PERMANENT INJURY OR DEATH. THE UNDERSIGNED VOLUNTARILY ELECTS TO ASSUME ALL RISK, ASSUMPTION OF RISK AND AGREES TO HOLD RELEASED PARTIES HARMLESS. (READ SEPARATE ASSUMPTION OF RISK, RELEASE AGREEMENT COMPLETELY PRIOR TO SIGNING)

RIDERS SIGNATURE:________________________________________DATE:___________

PARENT / GUARDIAN SIGNATURE:________________________________DATE:________
(must be signed if rider is under 18 years of age)

Please Fax completed form to (661) 268-8440 fax by June 22, 2009 to receive ride time.

FSEC c/o LIA COULOMBE, 11306 Sierra Hwy, Agua Dulce, Ca 91390

(PHONE 661-268-1715) OR FAX TO 661-268-8440

MAKE CHECK PAYABLE TO : COULOMBE



MINI HORSE SHOW                         (JULY 12th)

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 DATE OF SHOW:_________________________                              NO#____________

NAME OF RIDER:___________________________________________________________AGE:______________
ADDRESS:___________________________________________________________________________________
           ___________________________________________________________________________________

PHONE #__________________________CELL#_________________________FAX#_______________________
E-MAIL:_______________________________________________EMERGENCY#_________________________

HORSE NAME:_______________________________________________BREED:__________________________
AGE:________________COLOR:________________________________SEX:_____________________________
OWNER:_______________________________________SIGNATURE:___________________________________

CLASSES ENTERED (PLEASE CIRCLE)

1    2    3    4    5    6    7    8    9    10    11    12    13    14    15    16

17    18    19    20    21    22    23    24    25    26    27    28    29    30    31    32


CLASSES 1 - 13                                                                    ($13.00 each class) x ______classes    $______________

Day End High Point Reserve Champion and Grand Champion will be awarded to Jumpers & Halter &
combined classes 7,8,12,13

GROUNDS FEE PER HORSE:                                                                                                                $        15.00     

OFFICE FEE:                                                                                                                                      $            5.00

LATE FEE:     (All entries must be post marked 5 days prior to show date or entry
          will be considered late. A $15.00 late fee to be added if received after that date)                $______________

GRAND TOTAL:                                                                                                                                  $______________

ALL RIDERS MUST WEAR REGULATION HELMETS WHEN MOUNTED. IN ADDITION DERBY RIDERS MUST WEAR MEDICAL ARM BAND, AND REGULATION BODY PROTECTION VEST. THE UNDERSIGNED HAS READ AND UNDERSTANDS THE ASSUMPTION OF RISK AND RELEASE AGREEMENT. THE UNDERSIGNED RECOGNIZED AND AGREES THAT PARTICIPATING IN HORSE SPORTS, RANCHING, SCHOOLING, FARMING, AND HORSE RELATED ACTIVITIES IS DANGEROUS AND HAZARDOUS, AND MAY EVEN LEAD TO PERMANENT INJURY OR DEATH. THE UNDERSIGNED VOLUNTARILY ELECTS TO ASSUME ALL RISK, ASSUMPTION OF RISK AND AGREES TO HOLD RELEASED PARTIES HARMLESS. (READ SEPARATE ASSUMPTION OF RISK, RELEASE AGREEMENT COMPLETELY PRIOR TO SIGNING)

RIDERS SIGNATURE:________________________________________________DATE:____________________

PARENT / GUARDIAN SIGNATURE:___________________________________DATE:____________________
(must be signed if rider is under 18 years of age)                                                                                                                                                                      
Please send completed form and entry fee to (or Fax to 661-268-8440):
FSEC c/o LIA COULOMBE, 11306 Sierra Hwy, Agua Dulce, Ca 91390          (PHONE 661-268-1715)
MAKE CHECK PAYABLE TO : COULOMBE   
              

      FSEC SCHOOLING HORSE SHOW   (July 11)

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DATE OF SHOW:_____________________________                                                     RIDER NO#____________

NAME OF RIDER:___________________________________________________________AGE:______________

ADDRESS:__________________________________________________________________________________

__________________________________________________________________________________________

PHONE #__________________________CELL#_________________________FAX#_______________________

E-MAIL:_______________________________________________EMERGENCY#_________________________

HORSE NAME:_______________________________________________BREED:__________________________

AGE:________________COLOR:________________________________SEX:_____________________________

OWNER:_______________________________________SIGNATURE:___________________________________

CLASSES ENTERED (PLEASE CIRCLE) 1    2     3     4     5    6    7    8    9    10    11    12    13    14    15    16

17    18    19    20    21    22    23    24    25    26    27    28    29    30    31    32

CLASSES 1 & 2 JUMPING DERBY ONLY   ($20.00 each class) x ______classes $________

CLASSES 3 - 19                                  ($12.00 each class) x ______classes $________

DAY END HIGH POINT GROUP (circle HP group below you want to enter, add $10.00)

HP Groups (1,4,13,14) - (2,5,15,16) - (3,11,12,19) - (8,9,10,18) - (13,14,15,16)                    $__________ 

GROUNDS FEE PER HORSE:                                                                     $   20.00

OFFICE FEE:                                                                                         $     5.00

LATE FEE: (All entries must be post marked or faxed 10 days prior to show date or
entry will be considered late. A $15.00 late fee to be added if after that date)
                                                                                                   $_________

GRAND TOTAL:                                                                                                   $________

ALL RIDERS MUST WEAR REGULATION HELMETS WHEN MOUNTED. IN ADDITION DERBY RIDERS MUST WEAR MEDICAL ARM BAND, AND REGULATION BODY PROTECTION VEST. THE UNDERSIGNED HAS READ, UNDERSTANDS AND AGREES TO THE ASSUMPTION OF RISK AND RELEASE AGREEMENT. THE UNDERSIGNED RECOGNIZED AND AGREES THAT PARTICIPATING IN HORSE SPORTS, RANCHING, SCHOOLING, FARMING, AND HORSE RELATED ACTIVITIES IS DANGEROUS AND HAZARDOUS, AND MAY EVEN LEAD TO PERMANENT INJURY OR DEATH. THE UNDERSIGNED VOLUNTARILY ELECTS TO ASSUME ALL RISK, ASSUMPTION OF RISK AND AGREES TO HOLD RELEASED PARTIES HARMLESS. (READ SEPARATE ASSUMPTION OF RISK, RELEASE AGREEMENT COMPLETELY PRIOR TO SIGNING)

RIDERS SIGNATURE:________________________________________________DATE:____________________

PARENT / GUARDIAN SIGNATURE:______________________________________DATE:____________________(must be signed if rider is under 18 years of age)

Please send completed form and entry fee to:FSEC c/o LIA COULOMBE, 11306 Sierra Hwy, Agua Dulce, Ca 91390 (PHONE 661-268-1715) or Fax 661-268-8440

MAKE CHECK PAYABLE TO : COULOMBE
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