WWDC Membership/Waiver Application Form

Name   Farm/Business Name
Address   City   ST   Zip
Phone   E-Mail
Work/CP OR alternate E-Mail
Web Site   Discount to Members? Yes  No
SHORT Business Description

Membership runs January through December, dues are payable the first of January.
Type of Membership: FAMILY Membership 2-4 people. (Voting Privileges 18 years or older) OR SINGLE

Please print this form and mail (even if using PayPay, I do not get all the information on this form when submitted to PayPal). Pay Pal buttons below the waiver.
Make checks payable to WWDC and mail to: Tricia Hardy, 547 John Crotts Road, Mocksville, NC 27028

Full Year OR AFTER November 1st
 $25.00 FAMILY
 $15.00 SINGLE
AFTER June 30th 1/2 year
$12.50 FAMILY        
$ 7.50 SINGLE         Total Enclosed: $

WAIVER Signatures: I have read & Agree to the Waiver & indemnification below
1st Adult  
2ndt Adult

3rd Adult/Child  
4th Adult/Child


Whips and Wheels Driving Club Equine Release, Waiver and Indemnification The undersigned participant, and his or her parent or legal guardian if under the age of 18 years, does/do hereby execute this release waiver, and indemnification for himself/themselves and his or her/their heirs, successors, representatives and assigns and, thereby agree(s) and represents as follows:    To release Whips and Wheels Driving Club, it's members, agents and representatives affiliated with this activity from any liability, loss, damage, costs, claims and/or causes of action, including but not limited to all bodily injuries and property damage arising out of participation in the activity, it being specifically understood that said activity includes the handling of equine by the undersigned participant. The undersigned person(s) further agree(s) to indemnify Whips and Wheels Driving Club, it's members, agents and representatives affiliated with this project, and hold them harmless for any loss, damage, cost, claim judgment, or settlement which may be brought or entered against them as a result of the undersigned person's participation in said activity.   If involved in equine activities pursuant to NC Chapter 99E of NC General Statutes, the undersigned(s) executes(s) this waiver of the undersigned(s) right to sue and agree(s) to assume all risks resulting from the "intrinsic dangers of equine activities". "Intrinsic dangers of equine activities" is defined as those dangers or conditions that are an integral part of equine activities, including but not limited to: (i) the propensity of equines to behave in ways that may result in injury, harm, or death to persons on or around them; (ii) the unpredictability of an equine's reaction to such things as sounds, sudden movement, and unfamiliar objects, persons or other animals; (iii) certain hazards such as surface and subsurface conditions; (iv) collisions with other animals or objects; and (vi) the potential of a participant acting 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.   This waiver shall remain valid unless expressly revoked by the participant or Parent or guardian of a minor. The revocation shall be in writing, which shall be addressed to the provider and shall become effective thirty (30) days after delivery to the provider.  The undersigned(s) should maintain all medical and health insurance to cover all risks of any kind in any place in livestock, equine, and/or other activities.   I the undersigned participant will ensure equipment is in good condition at all times, wear and use all safety equipment. Minors (under the age of 18) MUST wear helmets and be accompanied by an experienced driver when in the carts/carriages.
WARNING: Under North Carolina law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina general statutes.

Full Yr OR AFTER Nov 1st
  
1/2 Yr AFTER June 30th