Anthem Day Eventing Liability Release Form InstagramThis field is for validation purposes and should be left unchanged.Contact DetailsParticipant Name(Required) First Last Email(Required) Enter Email Confirm Email Phone(Required)Emergency Contact Name(Required)Emergency Contact Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Waiver of liability, assumption of risk, covenant not to sue and release and hold harmless agreement.Please agree to and sign our liability release.Hold Harmless Release Form Consent(Required) I have read, understand, acknowledge, and confirm, and freely and voluntarily enter into this RELEASE and hold harmless agreement with Anthem Day Eventing LLC, Watkins Farm and their agents, servants, employees, or officers.I have read, understand, acknowledge, and confirm, and freely and voluntarily enter into this RELEASE and hold harmless agreement with Anthem Day Eventing LLC, Watkins Farm, Lacey Allison and their agents, servants, employees, or officers. I fully understand and acknowledge the potential danger that I or my child/children, other people, and/or horses by mounting, riding, walking, feeding, including but not limited to any interaction or participation with horses. I, by signing this waiver/release agreement agree to hold harmless, discharge, release and indemnify Anthem Day Eventing LLC, Watkins Farm,Lacey Allison and their agents, servants, employees, or officers, from all liability whatsoever and AGREE NOT TO SUE on account of or connection with in any way claims, causes of actions, injuries, damages, costs, expenses or loss to myself, my family, my children, my horse, my property, my friends, guests and/or any others as a result of any interaction or participation of any kind equine or otherwise that takes place at 281 Cassville White RD NW, Cartersville, GA, or any other location for schooling or showing, or any interaction or participation with horses except in the event of wanton or willful negligence. I hereby release and relieve Anthem Day Eventing LLC, Watkins Farm, Lacey Allison, and any affiliated companies, partnerships, employees, representatives, heirs, successors, and assign each and every member of his/her family from any liability whatsoever for any loss, claim, damage, injury, or death which I, my child, my horse, or any person claiming by, through, or under me may suffer or sustain as a result of participation or interaction of any kind, equine or otherwise that takes place at 281 Cassville White RD NW Cartersville, GA, or any off-site location for showing or schooling. I hereby waive any rights I may have to bring claim or suit against any said individuals arising out of any such damage, injury, or death. IT IS THE RESPONSIBILTY OF THE EQUINE PARTICIPANT to carry full and complete insurance coverage on his/her horse, personal property and himself/herself. I further understand and grant permission for treatment if an emergency medical treatment is required to be transported to the closest medical facility at my expense. I understand and agree and have accepted all rules and regulations that are currently in effect and may be established from time to time by Anthem Day Eventing LLC, Watkins Farm,Lacey Allison and their agents, servants, employees or officers. My failure to abide by such rules and regulations may result in Anthem Day Eventing LLC, Watkins Farm, Lacey Allison and their agents, servants, employees or officers prohibiting my participation in any equine related activities at Watkins Farm or any other location for showing or schooling under Anthem Day Eventing LLC. WARNING Under Georgia law, any equine sponsor or equine professional is not liable for an injury or death of a participant in equine activities resulting from the inherent risk of equine activities, pursuant to Chapter 12 of Title 4 of the Official Code of Georgia Annotated.Legal Consent to Electronic Form Signing(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically. You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below. Scope of Consent By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below. Paper Copies You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies. Withdrawal of Consent You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below. Withdrawing your consent, requesting a paper copy, or updating your contact information You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices. “Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address. “Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy . “Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number. The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.SignatureIs Participant a minor (under 18)?(Required) Yes – Participant is under the age of 18 No – Participant is over 18 If Participant is a minor, signature of parent/guardianDate(Required) Month Day Year Δ