2008 MEMBERSHIP WAIVER & FORM
MIDWEST MINNESOTA HARNESS CLUB
Name:
Address:
City: State: Zip:
Home Phone: Work: E-mail:
Single Membership is $25 per year.
YEARLY LIABILITY WAIVER
Voluntary Participation I agree that I, the undersigned, do
for myself or on behalf of my child, spouse, or legal ward,
hereby voluntarily participate in the events and that I/We
participate in the events totally at our own risk for injuries
or property damage we may incur in relation to events.
Incident Costs Responsibility and Medical Insurance Disclosure
I agree that I/We will be responsible for any and all costs
incurred by us for injuries or property damage I/We incur and
that I/We are covered by accident-medical insurance coverage
now in force.
Personal Responsibility I agree that I am responsible for
the negligent acts of my family members and/or legal wards
and animals, and I do carry personal liability insurance now
in force.
Personal Financial Losses I agree that I am responsible for
my own financial loss in relation to the theft or damage to
our tack, equipment, vehicles, trailers and horses while on
the premises where events are held.
Protective Headgear Warning I agree that I have been fully
warned and advised by this club that I should purchase and
wear protective headgear which meets or exceeds the quality
standards of the SEI CERTIFIED ASTM STANDARD F 1163 Equestrian
Helmet, while riding, driving, being and working near horses.
I understand that the wearing of such headgear may reduce severity
of some of the wearer’s head injuries and possibly prevent
the wearer’s death from happening as the result of a
fall or other occurrences.
Liability Release I agree that I hereby, for myself, my family
members, my heirs, administrators, personal representatives,
and assigns, do hereby hold harmless, release and discharge
this club, it’s owners, agents, employees, officers,
directors, representatives, assigns, members, premise owners,
affiliated organizations, insurers, and others acting on its
behalf, of all claims demands, causes of action, and legal
liability, whether the same be known or unknown, anticipated
or unanticipated due to this club’s ordinary negligence;
and I do further agree that except in the event of this club’s
gross negligence I shall bring no claims, demands, legal actions
and causes of action, against this club and its associates
as stated above in this clause for any economic and non-economic
losses due to bodily injury, death, property damage, sustained
by me and/or my minor child or legal ward in relation to the
premises and operations of this club, to include but not limited
to, while riding, driving, handling or otherwise being near
horses and other equine species.
STATEMENT OF AWARENESS
I, THE UNDERSIGNED, BEING OF LEGAL AGE, HAVE READ AND UNDERSTAND
THE FOREGOING AGREEMENT AND RELEASE.
Names of all minor participants in the events for whom I an
legally responsible:
1. ________________________________ 2. ________________________________
3. ________________________________ 4. ________________________________
EACH LEGAL AGE PARTICIPANT, PARENT OR LEGAL GUARDIAN MUST
SIGN:
Participant’s Name: _________________________________________
Spouses must sign for themselves: _____________________________
PLEASE SIGN AND RETURN THIS WAIVER/MEMBERSHIP
FORM ALONG WITH
YOUR DUES
TO: Midwest Minnesota Harness Club, PO Box 1059, Detroit Lakes,
MN 56502
