Updated 03-24-2016 (AP)
Dickinson State University Indoor/Outdoor Arena
Waiver of Liability, Indemnification and Medical Release
To be signed by adults participating in the event.
Acknowledgment and Assumption of Risk
I am aware of the dangers and the risks to my person and property involved in participating in equine related activities.
Activities other than equine related activities: ____________________________________________________________
_________________________________________________________________________________________________.
I understand that this activity involves certain risks for physical injury. I also understand that there are potential risks of
which I may not presently be aware. Because of the dangers of participating in this activity, I recognize the importance
and agree to fully comply with the applicable laws, policies, rules and regulations, and any supervisor’s instructions
regarding participation in this activity.
I 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.
I voluntarily elect to participate in this activity with knowledge of the danger involved, and I hereby agree 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, my
personal representatives, heirs, next of kin, successors and assigns, I forever:
A. waive, release, and discharge the State of North Dakota and its agencies, officers, and employees from any and
all negligence and liability for my death, disability, personal injury, property damages, property theft or claims of
any nature which may hereafter accrue to me, and my estate as a direct or indirect result of my participation in
the above referenced 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.
I hereby consent 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 participant, affirm that I am at least 18 years of age and 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 me regarding any losses I may sustain as a result of my participation. I agree that if any portion
is held invalid, the remainder will continue in full legal force and effect.
READ BEFORE SIGNING
Name (Please print): ____________________________________________
Signature: ____________________________________________ Date: ________________________
Witness Signature: _________________________________________ Date: ________________________
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
