MAIN STAY THERAPEUTIC FARM      6919 KEYSTONE RD    RICHMOND IL, 60071    815.653.9374   CONTACT US

DONATE To encourage, enrich and empower individuals through the therapeutic benefits of horses, animals and nature in an uplifting and nurturing setting. Main Stay is a place where bodies are challenged, minds embrace possibilities, and spirits are renewed.

 

Registration and Release form for Parents, Spouse, Caregiver, or Guardian

Name(s) of all those who may accompany rider to the farm:

LIABILITY RELEASE

I/We would like to participate in the Main Stay Therapeutic Farm, Inc. programs. I acknowledge the risks and the potential for risks of equine and animal interactions in a farm setting. However, I feel that the possible benefits to myself/my son/my daughter/my ward are greater than the risks assumed. I hereby, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against Main Stay Therapeutic Farm, Inc., its Board of Directors, instructors, therapists, aides, volunteers and/or employees for any and all injuries and/or losses I/my son/my daughter/ may sustain while participating in a Main Stay Therapeutic Farm, Inc. program. Under the Equine Activity Liability Act, each participant who engages in an equine or animal activity expressly assumes the risks of engaging in and legal responsibility for injury, loss, or damage to person or property resulting from the risk of equine activities. ~IL PWA-89-0111~

I have read and understand the above release, am over 18 and have the capacity to sign this release of my own free will.

Contact information

Main Stay Therapeutic Farm

6919 Keystone Rd., Richmond, IL 60071

Tel: 815.653.9374  Fax: 815.728.1224

Contact Us

info@mainstayfarm.org

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