Horsemanship Release Form Registration Name(Required) First Last Registration Email(Required) Address(Required)Please provide you address if you have not registered for a Community Climb Event before. If you have registered before, we will use your address linked with your email address. Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Phone number is required by state code for emergency contact.Emergency Contact(Required) Emergency Phone(Required)Phone number is required by state code for emergency contact.Participant List of Participants (use "A" for adult in age field.)(Required)Please enter all people who will be participating in horsemanship activities, including the person who is doing this registration if they are participating. Use “A” for adults in the age field.NameAge Add RemoveTHIS IS A RELEASE OF LIABILITY(Required)This RELEASE of LIABILITY is made and entered into hereinafter designated PHANTOM RANCH BIBLE CAMP and hereinafter designated PARTICIPANT, and Participant’s parent/guardian (only enter if participant is minor). In return for the use of the property, facilities and services of the Manager, the Rider, his heirs, assigns, and legal representatives, hereby expressly agree to the following: 1. It is the responsibility of the Participant to carry full and complete insurance coverage on his personal property and himself. 2. Participant agrees to assume ANY AND ALL RISKS INVOLVED IN OR ARISING FROM THE PARTICIPANT’S USE OF OR PRESENCE UPON PHANTOM RANCH BIBLE CAMP’S PROPERTY AND FACILITIES including, but not limited to, the risks of death, bodily injury, property damage, falls, kicks, bites, collisions with vehicles, horses and other animals or stationary objects, fire or explosion, the unavailability of emergency medical care, or the negligence or deliberate act of another person. 3. Participant agrees to hold Phantom Ranch Bible Camp and all of its successors, assigns, subsidiaries, affiliates, officers, directors, employees and agents completely harmless and not liable and release them from all liability whatsoever and AGREES NOT TO SUE them on account of or in connection with any claims, causes of action, injuries, damages, cost or expenses arising out of Participant’s use of or presence upon Phantom Ranch Bible Camp’s property and facilities, including without limitation, those based on death, bodily injury, property damage, including consequential damages, except if the damages are caused by the direct, willful and want on negligence of Phantom Ranch Bible Camp. 4. Participant agrees to waive the protection afforded by any statute or law in any jurisdiction whose purpose, substance and/or effect is to provide that a general release shall not extend to claims, material or otherwise, which the person giving the release does not know or suspect to exist at the time of executing the release. 5. Participant agrees to indemnify and defend Phantom Ranch Bible Camp against, and hold it harmless from, any and all claims, causes of action, damages, judgments, costs or expenses, including attorney’s fees, which in any way arise from the Participant’s use of or presence upon the Phantom Ranch Bible Camp’s property and facilities. 6. Participant agrees to abide by all of Phantom Ranch Bible Camp’s rules and regulations. 7. This contract is non-assignable and non-transferable and is made and entered into the State of Wisconsin, and shall be enforced and interpreted under the laws of this state. Should any clause be in conflict with State Law, then that clause is null and void. When Participant and Participant’s parent or guardian, if Participant is a minor, sign this contract, it will then be binding on both parties, subject to the above terms and conditions. I have read this release of Liability and Assumption of Risk Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.Payment Options If you select a quantity in Individual Climber field in order to make a payment online now. The Family rate is $20. Please select 2 for the qty to pay for your family. To pay on a later date, Individual Climber and Family Package quantities should be left blank to submit.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
