Required photo release, Emergency release, and Horse Liability Release Forms. AL ASSESSMENT WITH INDIVIDUAL INTERESTED IN SERVICES. THE SESSIONS WILL BE FILLED FIRST-COME, FIRST SERVED BASIS AS APPROPRIATE.
PHOTOS|MARKETING RELEASES Release For: Majestic Equine Connections, Inc.| I willingly accept photos/videos releases to be public for publicity purposes for Majestic Equine Connections, Inc. and The Caring Corral during participation in activities or on property for services. This may include but not limited to: Facebook, website, on news-television, magazine, instagram, display boards, Linkedin, audio/movie recordings, and/or any publicity purposes associated with Majestic Horse or Majestic Equine Connections, inc.. The purpose is for marketing the program and promotional reasons for grants, funding, enlisting new participants, and volunteers.
____________________________________________________________________________________ Emergency Contacts are required for clients and volunteers in case of an emergency. Two Emergency Contacts are required and the 3rd is helpful if the first two do not answer the phone. Yes, you have my permission to call emergency services if there is an emergency. This will be an option if the caregiver or guardian is not listed above and is not available through a phone call.
Majestic Equine Connections, Inc. has two addresses. Please contact Jennifer for which address the service will be held. The Westfield Road address is TBA for equestrian activities. 1. Current Horse Activities Address: 7460 Wooster Pike Rd. Seville, Ohio 44273 2. Chippewa Lake House: 7859 Westfield Road Medina, Ohio 44256 – NEW A Partner with Medina County Parks District
Health History is different from physical. Client/parent/guardian can fill out without a physician
HEALTH HISTORY
Diagnosis: Date of Onset: Please indicate current or past special needs in the following areas: Check box & explain if applies.
Pertains to Down Syndrome Only – Atlantoaxial Instability (Annual X ray Required) Only 10%-20% persons with Down Syndrome have positive cases.
CAUTION: READ CAREFULLY BEFORE SIGNING. ONE SIGNED COPY REQUIRED FOR EACH INDIVIDUAL WHO PARTICIPATES IN AN ACTIVITY.
I agree to the following Waiver, Agreement, and Liability Release with Majestic Equine Connections, Inc. and/or affiliated persons associated with the equine activities (referred to herein as “The Property Owners (“Danny & Jennifer Stankiewicz”), as a condition for its allowing me, and the other persons identified below, to do any of the following: enter any premises or facility where equine activities are conducted, be near horses in connection with any equine activities (handling, grooming, near, or riding horses). Agreement regardless of whether these activities take place under the supervision of “The Property Owner and Lessee” and its affiliates Majestic Equine Connections, Inc..at the following addresses: 7460 Wooster Pike Rd. Seville, Ohio 44273 and 7859 Westfield Road Medina, Ohio 44256.
Additional Participants with same Guardian/Parent adding on: I also make this agreement of behalf of the following, who are my children or legal wards:
All parts of the Waiver, Agreement, and Liability Release shall apply to me, and the children/legal wards listed above. (We will collectively call ourselves “I”, “me”, or “my”, throughout this agreement.) This Waiver, Agreement, and Liability Release will be binding at all times, now and in the future, even after my relationship with “The property Owner”. RELEASE STATEMENT I understand that parts of the activities may be physically or emotionally demanding. I affirm that I (or the participant) am in good health and am not under a physician’s care for any undisclosed condition that bears upon my (or their) ability to participate in this activity. I understand that “The property Owner” will offer safety equipment such as helmets. I recognize the inherent risk or injury or disability and understand that each participant must assume the risk of physical injury that could result. I release “The property owners” and volunteers from liabilities resulting from participating in these activities. This release is governed by the State of Ohio. WARNING Under the Ohio Equine Activity Liability Act, (Ohio Revised Code Chapter 2305.321) an equine professional is not liable for an injury or the death of a participant in an equine activity resulting from an inherent risk of equine activity. It is mutually understood and agreed that the liability release set forth herein shall constitute a waiver of liability beyond the provisions of the Ohio equine activity liability act. By signing this agreement and liability release, I agree not to bring any claim or suit against “The property owner” or volunteers, affiliated persons, and others acting on their behalf on the basis of any exception in that law. It is my intention to release and hold harmless “The property owner” or persons affiliated and entities associated with “The property owner” to the fullest extent allowed under the law. HELMETS/HEADGEAR I agree to be fully responsible for my own safety at all times. “The property owner” has suggested that I buy and wear a properly fitted ASTM-STANDARD/SEI-CERTIFIED EQUESTRIAN helmet when riding or near equines. I am not relying on “The property Owner” to provide a certified helmet for me, to check any helmet or strap that I may wear, or to monitor my compliance with this suggestion at any time. LIABILITY RELEASE: As consideration for being to enter on property, to be near equines in connection with any “The property owner/lessee” activities (regardless of who owns the equines), and/or engage in any other activity involving horses/equines, whether or not under “The property owner” supervision, I agree to assume full responsibility for any and all bodily injuries or damages which I may sustain when engaging in these and other activities. The term “damages,” means, for example, medical expenses, losses incurred because of bodily injuries or property damages, and/or personal property damages. I, for my heirs, administrators, personal representatives or assigns, release and discharge “The property owner” and its affiliated persons, and others acting on their behalf of and from any and all claims, demands, damages, actions, omissions, suits, or causes and action (present and future), whether the same by known or unknown, anticipated omissions, suits, or causes of action (present or future), whether the same by known or unknown, anticipated or unanticipated, resulting from or arising out of my bodily injury or damage that may be sustained, or property damage which may occur as a result of being on the property, handling horses, being near horses, and/or engaging in any other activity involving horses, whether or not under “The property owner” supervision. It is my intention to RELEASE/WAIVER OR HOLD HARMLESS Danny & Jennifer Stankiewicz (“The property Owner” and Lessee) or persons AFFILIATED with equine activities and/or other animals at the following address: 7460 Wooster Pike Rd. Seville, Ohio 44273. 7859 Westfield Road Medina, Ohio 44256 EQUINE-RELATED RISKS: I understand that anyone riding, handling, or even near a horse (referred to as “equine”) can suffer bodily and other injuries. Among other things, equines are unpredictable by nature. For example, frightened, angry, or under stress, the natural instincts of an equine are to jump forward or sideways or run away from danger by trotting or galloping. Equines are also known to kick, buck, rear up, back up quickly, spin around, strike, or bite. I know that equines can do any of these things without warning. I also understand that all equines, even if they have no known history of hurting people or animals, are powerful and can be dangerous to people, and other animals.
Under Ohio law (Ohio Revised Code Section 2305.321), horse owners and other parties are protected against liability for injuries that occur as a consequence of an inherent risk of equine activity
Majestic Equine Connections, Inc. Rules-Code of Conduct: https://majesticequineconnectionsinc.org Majestic I : 7460 Wooster Pike Road Seville, Ohio 44273 ● Please be Respectful to humans and animals. We have therapy horses and bunnies. ● Please be open to learning. ● Be kind with the use of language. ● Instructors Names: Katy or Jennifer ● Classes are up to 1-hour. Please be on time. Parking – In front of yellow barns in back. Please utilize turn-around in front of drive due to the 55 mph fast pace road (Wooster Pike/Rt 3) for safety. No parking on the grass. Thank you! What to Wear! ● Wear Closed-Toed Shoes such as boots with slight heel *Equestrian boots*, Older Pair of Tennis Shoes, regular boots and/or muck boots, trail shoes. (Tractor supply or Clothing Wearhouse has boots $5 or $10 bucks. ● May bring water, sunblock, wear hats. (We may have water bottles here). ● Summer : May wear t-shirts, tank-tops, shorts (non-riding) Winter: thick jackets and gloves. What NOT to Wear! ● High Heel boots, sandals, flip flops, new shoes, anything that has an open toe. ● Nothing too revealing with tops or high shorts. ● No vulgar messages on clothes. We are friendly and kind here. We hope you enjoy our services! Thank you to the Caring Corral’s partnership! MAIL TO: Majestic Equine Connections, Inc.,7460 Wooster Pike Rd. Seville, Ohio 44273 or email majesticequineconnections@gmail.com PH (440) 668-8364
