2022 Saddle Up Registration + Release

Saddle Up Registration & Release
First Last
Address
Address
City
State/Province
Zip/Postal

Please indicate current or past problems in the following areas

Allergies/Asthma
Bone/Joint
Breathing
Circulation
Communication
Digestion/Elimination
Hearing
Heart
Muscular
Pain
Sensation
Thinking/Cognition
Vision
Other

LIABILITY RELEASE

Client (18 years or older), Parent or Guardian

PHOTO RELEASE

I,
Client's name
Give Consent
hereby grant irrevocable and unlimited consent to the use and reproduction by Main Stay Therapeutic Farm, its assigns, licensees and legal representatives, of any and all photographs and any other audio/visual materials taken of me, my child or my ward, in all forms and media (including but not limited to printed media, digital media, web sites, video and audio productions). The materials may be reproduced in all forms including composite, altered or derivative works, for promotional material, educational activities, and exhibitions or for any other lawful use for the benefit of the program.

I hereby waive the right to inspect and approve the finished version(s) including any copy that may accompany the materials. I hereby release Main Stay and its employees, volunteers, assigns, licensees and legal representatives from all claims and liability relating to said materials. I sign this release as a person with, or the parent or guardian of a person with special needs, understanding that use of these materials will make them available to the general public. I have read and understand the above release, am over 18 and have the capacity to sign this release of my own free will. (18 years and
older)