Author: Erika Matulich
Company: Cypress Keep

Release and Hold Harmless Agreement

The Participant acknowledges the inherent risks that are involved in riding, driving, and working around horses. These risks may include, but are not limited to, damage to personal property, illness, bodily injury, trauma, or death resulting from a fall or while riding, driving, or being in close proximity to horses.

The Participant further understands that both horse and rider can be injured in the normal course of events while driving, hacking, schooling, or competing, and therefore agrees to indemnify and hold harmless Cypress Keep Farm, Black Dog Farm, Greenridge Farm, its owners, employees, and its guest instructors, and further release them from any liability or responsibility for any accident, injury, damage, or death to the Participant or any property or horse the Participant owns, or to any family member or spectator accompanying the Participant while on the premises of Cypress Keep, Black Dog Farm, or Greenridge Farm.

Signature of Participant								Date

Printed Name of Participant

Signature of Parent or Legal Guardian (if Participant in under 18 years of age)

Address					City		State			Zip code

Home Telephone				Work Telephone

Email Address or other contact information 

Horse Name			Breed			Color		Gender		Age

Accession Number on Coggins Test			Date of Test

Veterinarian Name			Phone #

Cypress Keep 
www.cypresskeep.com
John Porter and Erika Matulich
4909 Stanley Road   Plant City, Florida 33565
cypresskeep@starband.net
(813) 982-2200 [phone]   (813) 982-9709 [fax]

Please bring your original Coggins certificate to your event at Cypress Keep.