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About
About DEFHR
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DEFHR Equine Ambassadors
Resources
Horses
Adoption Process
Available Horses
Horses in Rehabilitation
Equine Transition Service
Owner Assistance
Owner Listings
Get Involved
Visit
Schedule Farm Tour
Volunteer
Getting Started
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Home
About
About DEFHR
Team
Success Stories
DEFHR Equine Ambassadors
Affiliations
Financial Statements
Resources
Horses
Adoption Process
Available Horses
Horses in Rehabilitation
Equine Transition Services
Owner Assistance
Owner Listings
Get Involved
Visit
Schedule Farm Tour
Volunteer
Getting Started
Volunteer Opportunities
Educational Opportunities
Education Programs
Internships
Careers
Grooming Sponsorship
News & Events
Calendar
News
Donate
Join the Herd
Other Ways to Give
Donate Now
Contact
Menu
Home
About
About DEFHR
Team
Success Stories
DEFHR Equine Ambassadors
Affiliations
Financial Statements
Resources
Horses
Adoption Process
Available Horses
Horses in Rehabilitation
Equine Transition Services
Owner Assistance
Owner Listings
Get Involved
Visit
Schedule Farm Tour
Volunteer
Getting Started
Volunteer Opportunities
Educational Opportunities
Education Programs
Internships
Careers
Grooming Sponsorship
News & Events
Calendar
News
Donate
Join the Herd
Other Ways to Give
Donate Now
Contact
Search
Search
Close this search box.
Home
About
About DEFHR
Team
Success Stories
DEFHR Equine Ambassadors
Affiliations
Financial Statements
Resources
Horses
Adoption Process
Available Horses
Horses in Rehabilitation
Equine Transition Services
Owner Assistance
Owner Listings
Get Involved
Visit
Schedule Farm Tour
Volunteer
Getting Started
Volunteer Opportunities
Educational Opportunities
Education Programs
Internships
Careers
Grooming Sponsorship
News & Events
Calendar
News
Donate
Join the Herd
Other Ways to Give
Donate Now
Contact
Menu
Home
About
About DEFHR
Team
Success Stories
DEFHR Equine Ambassadors
Affiliations
Financial Statements
Resources
Horses
Adoption Process
Available Horses
Horses in Rehabilitation
Equine Transition Services
Owner Assistance
Owner Listings
Get Involved
Visit
Schedule Farm Tour
Volunteer
Getting Started
Volunteer Opportunities
Educational Opportunities
Education Programs
Internships
Careers
Grooming Sponsorship
News & Events
Calendar
News
Donate
Join the Herd
Other Ways to Give
Donate Now
Contact
Participant Release
“
*
” indicates required fields
Step
1
of
6
16%
Participant Information
Name
*
First
Last
Date of Birth
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Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
*
Mobile Phone
*
Work Phone
Email
*
Parent/Guardian Information
Parent/legal guardian name (for participants under the age of 18)
First
Last
Parent/legal guardian address
Street Address
City
State / Province / Region
ZIP / Postal Code
Home Phone
Mobile Phone
Work Phone
Email
Emergency Information
Name
Relationship to participant
Home Phone
Mobile Phone
Work Phone
Name
Relationship to participant
Home Phone
Mobile Phone
Work Phone
Do you have any health condition that could affect your ability to volunteer safely At DEFHR?
Yes
No
If yes, please discuss with the volunteer coordinator.
Signature
*
Date
*
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Please read the following carefully, check beside each statement, and sign at the end.
*
I understand that horses are independent living beings and can be unpredictable.
I understand that there are always elements of risk in equestrian activities, including permanent disability or death, that common sense and personal awareness can help reduce.
I am aware that at all times when at Days End Farm Horse Rescue, it is MY RESPONSIBILITY to read and obey all posted information and warnings, and comply promptly with all verbal directions of DEFHR staff and instructors.
I am aware that at all times when riding, it is MY RESPONSIBILITY to practice appropriate handling etiquette, ride with another person, check to ensure integrity of all equipment and tack, ride with proper equipment (regulation helmet with a fastened chin strap and heeled boots).
I am aware that cameras are installed at DEFHR as a measure of security and safety for the horses, people, and property.
I understand that this is only a partial list, and I must be safety conscious and exercise sound judgment AT ALL TIMES. ANYONE found to be endangering themselves, other people, or horses faces immediate revocation of handling/riding privileges WITHOUT EXCEPTION.
I hereby acknowledge and assume the risk of participating in any and all horse related activities, including riding, at DEFHR or in any and all locations where DEFHR activities take place. I do hereby, waive, release and forever discharge, and indemnify and hold harmless DEFHR, its officers, staff members, volunteers, instructors, advisors, and/or agents from any and all claims, suits, actions, damages, losses, liability, cost, and expenses (including attorney fees and court costs) of any kind or nature whatsoever, incurred for injuries and/or damages to person and/or property. I understand that participation in activities at DEFHR are potentially hazardous and can result in serious injury. I release DEFHR from responsibility for accidental physical injury, including death or illness and loss of personal property while at DEFHR.
I agree to remain fully liable and responsible for any such hospital, doctor, ambulance, dental, or medical fees in the event of an injury to me as a result of my participating in any and all activities involving DEFHR. I understand that DEFHR does NOT provide health, accident, or liability insurance to participants.
I acknowledge that there is a valid consideration to executing this release. The invalidity of any statement or waiver of rights above under local, state, or federal law does not invalidate any other statement or waiver of rights above.
Select All
Signature
*
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Photo Release
I do
I do not
consent to and authorize the use and reproduction by Days End Farm Horse Rescue, Inc. of any and all photographs and any other audio/visual materials taken of me for promotional material, educational activities, exhibitions, or for any other use for the benefit of DEFHR.
Signature
*
Date
*
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Authorization for Treatment (optional)
The undersigned participant, and parents or legal guardian of a minor participant, authorizes members of DEFHR as agent(s), to consent to any x‑ray, anesthetic, medical, or surgical diagnosis or treatment and hospital care deemed advisable and rendered by any licensed physician, licensed emergency medical technician, or surgeon, whether on DEFHR property, in a remote location, in an office, or in a licensed hospital. This authorization is given in advance of any required care to empower the agent(s) to give consent for such treatment as the health caregiver may deem advisable. This authorization shall remain effective indefinitely unless revoked in writing.
Signature
Date
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Health insurance carrier
Policy number
Health insurance phone
Family physician
First
Last
Family physician phone
Family physician address
Street Address
Address Line 2
City
State
ZIP / Postal Code
Name
This field is for validation purposes and should be left unchanged.
11629
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