Triple Waiver

The form is now an all-in-one bundle that includes the Release and Liability, COVID-19 Release and Protocol, and Emergency Contact Form. All clients and campers must have the below form completed. PLEASE NOTE: it will not let you submit if you have forgotten to fill out a required area, if not applicable please write N/A. WE ARE NO LONGER ACCEPTING PAPER VERSIONS OF ANY OF OUR FORMS.

BOULDER POINTE EMERGENCY CONTACT FORM

* Indicates required field

Name of Participant *

First

Last

Name of Parent/Guardian if under 18 y.o. *

First

Last

Participant DOB *

Phone Number *

Email *

How did you Register? *

Date of Camp or Lesson Start *

Participant Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Name *

First

Last

Secondary Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Secondary Emergency Contact Phone Number *

Relationship to Particpant *

Parent/Guardian Extended Family Friend Other

Secondary Contact Relationship to Participant *

Parent/Guardian Extended Family Friend Other

List of persons approved to pick up and/or assume responsibility for your child. Include phone number. *

Persons NOT authorized to pick up or drop off your child (please email legal documents): *

Do you or your child have any health concerns (medications, allergies, chronic conditions, behavioral or mental disabilities) that we should know about in order to facilitate safe and successful participation? *

Please write any medications participant is taking and frequency *

Please give any additional information concerning you or your child, which may be helpful: *

AUTHORIZATION FOR EMERGENCY MEDICAL CARE

I hereby give permission to the Boulder Pointe Equestrian and Event Center,LLC staff to secure emergency medical and/or surgical treatment for myself or my child while in their care. All expenses of such care will be accepted by myself or the parent(s)/legal guardian, including fees for an ambulance, if deemed necessary by staff. I realize attempts to reach me or my emergency contact person prior to any decisions will be made unless a life-threatening situation is at hand or circumstances do not allow.

Authorization for Emergency Medical Care *

Yes

Signed *

First

Last

Date Signed *

BOULDER POINTE WAIVER AND INFORMED CONSENT TO PARTIPATE IN EQUESTRIAN ACTIVITIES

NOTICE: Please read this document. Signing or acknowledging review of this document affirms that you have read it and understand it in its entirety. The Equine Activity Liability laws of the State of Minnesota, Ch. 604A.12 Subdivision 2, requires the following notice:

NOTICE OF INHERENT RISKS: Equines have the propensity to behave in ways that may result in injury, harm or death to persons on or around the equine; have unpredictable reactions to such things as sounds, sudden movement and unfamiliar objects, persons or other animals; are susceptible to certain hazards such as surface or subsurface conditions, collisions with other equines or objects; propensities include kicking, biting, stamping, stumbling, rearing, and others; tack equipment can fail resulting in falling or loss of control; and activities have the potential of a participant to act in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the equine or not acting within the participant’s ability. Equine activities are INHERENTLY DANGEROUS.

WAIVER AND INFORMED CONSENT TO PARTICIPATE
I, the undersigned, having read and understood the content of this document, agree and consent to the provisions contained herein. It is my intention and desire to participate in equestrian-related activities including but not limited to, riding, horse-handling or being present at equestrian activities as an observer or other activity related, however slight, to equestrian activities at events held at Boulder Pointe owned or leased facilities and their foster host facilities.

I hereby acknowledge that I am fully aware of the nature, purpose and risks of equine activities. I acknowledge that these activities are potentially dangerous and that I voluntarily accept any of the inherent risks involved. In consideration for my being permitted to take part in these activities, I agree to be bound by the rules and to obey the directions of the owners. I agree to release, hold harmless, and keep indemnified Boulder Pointe Equestrian & Event Center, LLC, its Members, officers and Andrea Keacher/Andrea Gustafson from and against all claims, actions, costs, expenses and demands in respect to death, injury, loss or damage to my person or property, howsoever caused, arising out of or in connection with my taking part in these events even if the same may have been contributed to or occasioned by the negligence of the said body or any of its agents, servants, or representatives. It is understood and agreed that this agreement is to be binding upon myself, my heirs, executors and assigns under the laws of the State of Minnesota related to Equine Activity Liability.

I UNDERSTAND THAT THIS IS A LEGAL DOCUMENT. I HAVE READ AND UNDERSTOOD THIS RELEASE AND I UNDERSTAND ALL ITS TERMS. I EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS MEANING AND SIGNFICANCE. I HEREBY ASSUME ALL OF THE RISKS ASSOCIATED WITH EQUINE RELATED ACTIVITIES

I confirm I have read, acknowledge, and accept the terms of the Waiver and Informed Consent.

I also confirm I have read the Stable Rules and all rules applicable to the Boulder Pointe facilities and will comply with them.

I hereby give permission to the Company staff to secure emergency medical and/or surgical treatment for my child or myself while I am on the property or my child is in their care. All expenses of such care will be accepted by myself or the parent(s)/legal guardian, including fees for an ambulance, if deemed reasonably necessary by staff. Company will make attempts, when possible, to reach my emergency contact person or the parent/guardian prior to medical treatment; but this may not be possible in all situations.

The Rider must sign this document if the Rider is 18 years of age or older. A parent/guardian must sign this Release on behalf of a minor child (17 years of age or younger).

Signed *

First

Last

Date Signed *

Click Here to Agree *

By Checking this box I am agreeing that I am 18 y.o. or older and I agree to the terms presented above.

RELEASE FORM AND ACKNOWLEDGMENT OF POLICIES FOR COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
Boulder Pointe Equestrian & Event Center, LLC (“Company” or “Boulder Pointe”) has put in place preventative measures to reduce the spread of COVID-19 at its locations and facilities, including employee and client policies requiring social distancing and more frequent cleanings of high touch surfaces. However, Company cannot guarantee that an employee or customer/client will not become infected with COVID-19.
By signing this agreement, I, _________________________ (the “Rider”), acknowledge the following. If I am signing on behalf of a minor child as indicated in the signature block, representations apply to the minor child I am signing on behalf of. If both I and my child will be present at Company’s facility, a separate release must be completed for each of us.

I certify that I am at the barn for recreation, lessons and/or to care for my horse.
I do not currently have symptoms associate with COVID-19 (e.g. cough, fever, shortness of breath, loss of taste and smell, etc…, CDC guidance is available from management should I have questions about possible symptoms), and I have not had such symptoms within the last fourteen (14) days.
To my knowledge, I have not been exposed to an individual with COVID-19 symptoms in the last fourteen (14) days, including any family, friends, etc… If I develop COVID-19 symptoms, I must follow all CDC guidance and any requirements requested by my doctor or other medical professional.
If I am notified that I have been exposed to an individual with COVID-19 symptoms or that has developed COVID-19, I must follow all CDC guidance and any requirements requested by my doctor or other medical professional.
By coming to Company’s location for services or to participate in Company events, I will be deemed to have recertified that #1 and #2 above are true with respect to that day. I acknowledge that the Company may require an onsite verbal or written questionnaire concerning COVID-19 prior to entry into the facility.
I acknowledge the contagious nature of COVID-19 and understand the risk that I may be exposed to or infected by COVID-19 by virtue of my presence at Company’s facility, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. By signing this waiver, I hereby waive any COVID-19 injury, illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my presence at Company’s facility (“Claims”). On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless the Company, its employees (including Andrea Keacher/Andrea Gustafson), agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the negligence of the Company, its employees, agents, and representatives in relation to COVID-19. This waiver specifically excludes any claims that cannot be waived by law.
I will follow all Company policies concerning COVID-19 to the best of my ability, including any restrictions mandated by local, state, and federal law, if applicable. These policies include:
- While you are at the barn:
  - You MUST not come to the barn at any time if you are exhibiting any signs or symptoms of COVID-19, or have been exposed or potentially exposed to anyone who may have COVID-19.
  - You must continue to clean up after yourself in outdoor areas and the outdoor arena
- These policies may be subject to change at the discretion of Company. Please see Andrea Keacher/Andrea Gustafson for the most recent set of Company facility policies.
I hereby give permission to the Company staff to secure emergency medical and/or surgical treatment for my child or myself while I am on the property or my child is in their care. All expenses of such care will be accepted by myself or the parent(s)/legal guardian, including fees for an ambulance, if deemed reasonably necessary by staff. Company will make attempts, when possible, to reach my emergency contact person or the parent/guardian prior to medical treatment; but this may not be possible in all situations.

The Rider must sign this Release if the Rider is 18 years of age or older. A parent/guardian must sign this Release on behalf of a minor child (17 years of age or younger).

COVID-19 Camp Policy and Release

Masks are optional.
No parents are allowed to stay and watch the camp or come back to the barn early before designated pick-up time.
For my little horse camp, only (1) parent is allowed to be with the child attending. No other adults or children are allowed.
We have hand sanitizer set up around the facility, but also encourage each camper to bring a little bottle for personal use.
We will not have our Culligan water machine active so please make sure to bring an appropriate amount of water for your child during the day.
We will be outside unless deemed necessary. We will be inside if actively raining, thundering or lightening, or if heat index is 90 degrees or above.
We reserve the right to send any child home that we feel is exhibiting signs/symptoms of COVID-19.

Signed *

First

Last

Check Here to agree *

By Checking this box I am agreeing that I am 18 y.o. or older and I agree to the terms presented above.

Date Signed *

Acknowledgment of Policies Specific to Camps

Use of Hand Stamps
For the purpose of organizing and keeping track of campers Boulder Pointe will mark the hands of campers with a colored stamp. The stamp color will indicate which group they will be a part of during the day and aid counselors in organizing activities.

Late Drop-Off and Pick Up Policy
Parents and guardians must contact Boulder Pointe if they will be late to pick up their camper. There will be a 15 minute grace period after the stated camp start and end time after which a fee of $1/minute late will be applied.

I confirm I have read, acknowledge, and accept the terms of the policies stated heretofore.

Check Here to Agree *

Acknowledged

ACKNOWLEDGEMENT OF ABOVE POLICIES

Electronic Signature 18 y.o. and older, this agreement remains active unless revoked in writing with confirmation *

Check to Acknowledge Electronic Signature *

Acknowledged

Date of Signature *

Submit

BOULDER POINTE EQUESTRIAN AND EVENT CENTEREMERGENCY CONTACT INFORMATION​Waiver and Informed ConsentRelease and acknowledgment of COVID-19 Policies​

BOULDER POINTE EMERGENCY CONTACT FORM

BOULDER POINTE WAIVER AND INFORMED CONSENT TO PARTIPATE IN EQUESTRIAN ACTIVITIES

RELEASE FORM AND ACKNOWLEDGMENT OF POLICIES FOR COVID-19

Acknowledgment of Policies Specific to Camps

ACKNOWLEDGEMENT OF ABOVE POLICIES

BOULDER POINTE EQUESTRIAN AND EVENT CENTER

EMERGENCY CONTACT INFORMATION
Waiver and Informed Consent
Release and acknowledgment of COVID-19 Policies