Release and Hold Harmless Agreement
The Participant acknowledges the inherent risks which 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, 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. The

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

Please print this form from your browser, fill it out, and bring with your original Coggins certificate to your event at Cypress Keep. You can also download this form to your Microsoft Word.
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Cypress Keep Services
 John Porter  and Erika Matulich      4909 Stanley Road    Plant City, Florida 33565
 [email protected]   (813) 982-2200 [phone]   (813) 982-9709 [fax]