Updated 03-24-2016 (AP)
Dickinson State University Indoor/Outdoor Arena
Parent’s or Guardian’s Agreement of
Waiver of Liability, Indemnification and Medical Release
To be signed by adults if the participant is under 18 years of age.
Acknowledgment and Assumption of Risk
The undersigned parent and/or legal guardian does hereby acknowledge that he/she is aware of the dangers and the risks
to the participant’s person and property involved in participating in equine related activities.
Activities other than equine related activities: ______________________________________________________________________
___________________________________________________________________________________________________________.
The undersigned parent and/or legal guardian and participant understand that this activity involves certain risks for physical injury to
the participant. We also understand that there are potential risks of which may presently be unknown. Because of the dangers of
participating in this activity, the undersigned parent and/or legal guardian and participant recognize the importance and the
participant agrees to fully comply with the applicable laws, policies, rules and regulations, and any supervisor’s instructions
regarding participation in this activity.
The undersigned parent and/or legal guardian and participant understand that the State of North Dakota (State) does not insure
participants in the above-described activity, that any coverage would be through personal insurance, and the State has no
responsibility or liability for injury resulting from this activity.
The undersigned parent and/or legal guardian acknowledges that the participant voluntarily elects to participate in this activity
with knowledge of the danger involved, and hereby agrees to accept and assume any and all risks of property damage, personal
injury, or death.
Waiver of Liability and Indemnification:
In consideration for being allowed to voluntarily participate in the above-referenced event, on behalf of myself, the participant,
his/her personal representatives, heirs, next of kin, successors and assigns, the undersigned parent and/or legal guardian forever:
A. waives, releases, and discharges the State of North Dakota and its agencies, officers, and employees from any and all
liability for the participant’s death, disability, personal injury, property damages, property theft or claims of any nature
which may hereafter accrue to the participant, and the participant’s estate as a direct or indirect result of participation in
the activity or event; and
B. defend, indemnify, and hold harmless the State of North Dakota, its agencies, officers and employees, from and against
any and all claims of any nature including all costs, expenses and attorneys’ fees, which in any manner result from
participant’s actions during this activity or event.
Consent is given for the participant to receive medical treatment, which may be deemed advisable in the event of injury, accident or
illness during this activity or event. This release, indemnification, and waiver shall be construed broadly to provide a release,
indemnification, and waiver to the maximum extent permissible under applicable law.
I, the undersigned parent and/or legal guardian, affirm that I am freely signing this agreement. I have read this form and fully
understand that by signing this form I am giving up legal rights and/or remedies which may otherwise be available to myself, the
minor participant regarding any losses the participant may sustain as a result of participation in the activity. I agree that if any
portion is held invalid, the remainder will continue in full legal force and effect.
READ BEFORE SIGNING
Name of Minor (Please print): _________________________________________ Age of Minor: ___________
Name of Parent/Legal Guardian (Please Print): _____________________________________
Signature of Parent/Legal Guardian: _____________________________________ Date: __________________
Witness Signature: _____________________________________ Date: __________________
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