WWDC /Paradox Driving Derby Entry Form   Date of Event: Sept 30-Oct 1, 2017   

            Check:______    Cash:_______  OR  PayPal invoice _________ (E-mail Tricia@WhipsandWheelsDrivingClub.org)

Driver/Rider’s Name:_____________________________ Equine’s ame:___________________________

Address: _____________________________________   Check One:  Horse/Mule____, Pony ____, Mini____

City:  __________________________ ST:____ Zip:_______  Navigator Name:________________________

Phone:__________________________________   E-Mail:___________________________________            

Signature of Adult if a Minor
is the Driver or Rider:______________________________________

If Driver/Rider is a minor (under 18 years old) they MUST wear a helmet!                                        

Whips & 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.

Please Sign BOTH Waivers

Print and mail to:
Tricia Hardy, Show Secretary 547 John Crotts Road, Mocksville NC 27028

Paradox Farm 145 Paradox Lane, Mocksville, NC 27028

                                 (Name of Stable)   (Address)

Release and Hold Harmless Agreement

WHEREAS, the UNDERSIGNED acknowledges the inherent risks involved in riding and working around horses, which risks include bodily injury from using, riding or being in close proximity to horses, among other risks, and further, that both horse and rider can be injured in normal use or in competition and schooling;

IN CONSIDERATION, therefore, for the privilege of riding and/or working, around horses at Paradox Farm. the undersigned does hereby agree to hold harmless and indemnify Paradox Farm and further release them from any liability or responsibility for accident, damage, injury, or illness to the Undersigned or any horse owned by the Undersigned or to any family member or spectator accompanying the Undersigned on the premises of Paradox Farm.

Date:  _________          (Signature)_____________________________________________________________________

(Print Name & Address)_________________________________________________________________________________________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Helmet Clause- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Initial Appropriate Line:

____*By law, all riders, drivers, and navigators under 18 years of age must wear appropriate headgear.

____*AII riders, driver, and navigators over 18 years of age are not required to wear a helmet, but it is strongly recommended.

Sign Appropriate Line::
                                                                                                                       

I, ____________________________________, choose to wear appropriate headgear.

I, ____________________________________, choose not to wear any headgear.