General Liability Form PONY POWER THERAPIES, LLCGENERAL WAIVER OF LIABILITY I acknowledge the risks and potential for risks of horse activities. However, I feel that the possible benefits to my self, my son, my daughter, my ward are greater than the risk 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 Pony Power Therapies, Inc., its Board of directors, instructors, therapists, volunteers and/or employees for any and all injuries and/or losses I may sustain while participating in Pony Power Therapies, Inc. By checking below, I agree to the terms. Attendee Information First Name Last Name Date of Birth Is the above person 18 or older?YesNo Cell Phone Email Parent/Guardian Information Parent/Guardian First Name Parent/Guardian Last Name Parent/Guardian Phone Parent/Guardian Email Are you a...VolunteerParticipantParent/GuardianOther Attendee's Address Address Line 1 Address Line 2 City StatePlease select... AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY MH GU MP PR VI Zip Code I consent to and authorize the use and reproduction by Pony Power Therapies of any and all photographs and any other audio/visual materials taken of me for promotional material, educational activities, exhibitions or for any other use for the benefit of the program.YesNo I have read and understand the above general waiver of liability. By clicking yes and signing below, I am agreeing to its terms.Yes I have read and understand the above assumption of risk, waiver of liability and release relating to COVID-19. By clicking yes and signing below, I am agreeing to its terms.Yes Date Emergency Contact Information Emergency Contact First Name Emergency Contact Last Name Emergency Contact Phone