Breakaway Farm
16 US Route 2
Grand Isle, VT, 05458
802 372 8491

WARNING

Under Vermont Law, an equine activity sponsor is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities that are obvious and necessary, pursuant to 12 V.S.A. § 1039.

I will be using the following services from Breakaway Farm/ Green Mountain Mules:

Trail ride______Pony Ride ______Private Lesson______Group Lesson______Other______

In consideration of being allowed to rent a horse or other equine from Breakaway Farm/ Green Mountain Mules for the purpose of recreational activities, I ……………….., the undersigned, acknowledge, appreciate and agree that:

  1. The risk of injury from horseback riding is significant, including the potential for permanent paralysis and death, and while particular skills, equipment and personal discipline may reduce this risk of serious injury, the risk does exist; and,
  2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASESS or others, and assume full responsibility for my participation; and
  3. I willingly agree to comply with the stated and customary terms and conditions while participating in this activity. If, however, I observe any unusual significant hazard during my presence or participation, I will bring such to the attention of the releasees immediately; and,
  4. I acknowledge that I have been strongly urged to wear an approved helmet and riding boots while utilizing the facilities or trails and that if I refuse to wear them I am making a conscious decision to risk serious injury or even death. I further understand that, if I am a minor, I will not be allowed to use the facilities without wearing all of the approved safety items; and,
  5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY and HOLD HARMLESS BREAKAWAY FARM/ GREEN MOUNTAIN MULES, its owners, officers, officials, agents and or employees and if applicable owners or lessors of the premises used for this activity. WITH RESPECT TO ANY OR ALL INJURY, DISABILITY, DEATH, or loss or damage to person and property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEE OR OTHERWISE, to fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT AND FULLY UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT

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Participant's signature Age Date

FORPARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE( UNDER 18 YEARS AT THE TIME OF REGISTRATION)
This is to certify, that I, as parent/guardian with legal responsibility for this participant do consent and agree to his /her release as provided above for all the releases, and, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, agree to RELEASE, INDEMNIFY and HOLD HARMLESS BREAKAWAY FARM/ GREEN MOUNTAIN MULES, its owners, officers, officials, agents and or employees and if applicable owners or lessors of the premises used for this activity. WITH RESPECT TO ALL liabilities incident to the minor child’s involvement or participation in any or all activities as provided above, EVEN IF ARISING OUT OF THE NEGLIGENCE OF THE RELEASEE, to the fullest extent of the law.

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Parent or Legal Guardian's signature if minorPRINT NAME Date

Rules

1. All visiting horses must produce, or have on file with Breakaway Farm, a current, (within one year) negative Coggins Test.

  1. Please leave your dogs at home.
  2. Speed limit on the farm is 5 mph.
  3. Parking is in approved parking places only.

4. Please place all trash in the proper receptacle.

5. Please do not dump manure on the property.

6. In the interest of safety, both in the barn and in the fields, there is a No Smoking policy.

7. All gates that are closed are to remain closed and all gates that are open are to remain open.

8. The arena is available for use. The gate must remain closed at all times and please put any equipment back the way you found it..

11. All minors MUST wear approved helmets while mounted. No exceptions.

  1. Be considerate.

13. We highly recommend that you not ride or school alone. If you do not have a schooling partner, we will be happy to try to group you with someone.

14. Use Common Sense! The purpose of this establishment is to provide a safe, inviting environment for all riders to enjoy their experience. Bear in mind at all times that the other horses and/or riders may well be as, or even more, inexperienced than you or your horse and give them the consideration you would want for yourself.