Sundance Circle Hippotherapy LLC -
Sundance Circle Hippotherapy Foundation
Adult Volunteer Release and Indemnification Agreement
This Adult Volunteer Release and Indemnification Agreement (the "Agreement") is being entered into as of the date signed below by:
Volunteer Name: ____________________________________________________
Street Address: ___________________________________________________
City, State, Zip: ____________________________________________________
Telephone Number: ________________________________________________
WHEREAS, Sundance Circle Hippotherapy LLC ("Sundance") and Sundance Circle Hippotherapy Foundation provide hippotherapy and equine-assisted occupational, physical and speech therapy services at an equestrian facility (the "Facility") located at 16516 92nd St East, Sumner, Washington 98390; and
WHEREAS, Volunteer desires to visit the Facility and participate as a volunteer in Sundance’s equine programs, which may include, but are not limited to, leading horses, side-walking, horse care, grooming, tacking, barn chores, and general facility maintenance; and
WHEREAS, in consideration of Sundance permitting Volunteer to visit the Facility and participate in such volunteer activities, Volunteer agrees to release and indemnify Sundance and certain other parties from all claims as set forth in this Agreement.
NOW, THEREFORE, Volunteer agrees as follows:
1. Volunteer's Representations and Warranties
Volunteer makes each of the following representations and warranties on behalf of Volunteer and Volunteer's heirs, guardians, successors, assigns, and legal representatives (collectively, the "Volunteer Parties"):
(a) Volunteer is at least eighteen (18) years of age.
(b) Volunteer is physically, mentally, and emotionally able to perform the duties assigned to Volunteer in a safe and responsible manner and will promptly notify Sundance if Volunteer becomes unable to safely perform such duties.
(c) Volunteer is capable of exercising sound judgment and conducting themselves in a manner that promotes the safety and well-being of animals, patients, staff, other volunteers, and members of the public.
(d) Volunteer is not under the influence of alcohol, illegal drugs, cannabis (to the extent it would impair performance), or any other substance that could impair Volunteer’s judgment, alertness, or ability to safely perform volunteer duties at the time Volunteer begins service.
(e) Volunteer will not use, possess, or be under the influence of alcohol, illegal drugs, or any substance that impairs Volunteer’s ability to safely perform volunteer duties while on Sundance’s premises, participating in Sundance activities, or otherwise acting on behalf of Sundance.
(f) Volunteer will comply with all applicable Sundance policies, procedures, training requirements, safety protocols, animal handling requirements, infection control practices, and instructions provided by Sundance.
(g) Volunteer understands that participation may involve interaction with animals, patients, medical personnel, and the public, and agrees to conduct themselves in a professional, respectful, compassionate, and responsible manner at all times.
(h) Volunteer acknowledges that, in the course of volunteering, Volunteer may have access to confidential, proprietary, medical, patient, client, donor, personnel, or other sensitive information. Volunteer agrees to maintain the confidentiality of such information and to comply with all applicable confidentiality, privacy, and data protection requirements, whether arising under Sundance policies or applicable law.
(i) Volunteer will immediately report any injury, animal incident, safety concern, exposure, confidentiality breach, or other event that could affect the health, safety, welfare, or privacy of animals, patients, staff, volunteers, or Sundance.
(j) All information provided by Volunteer in connection with Volunteer’s application, screening, training, and service is true and complete to the best of Volunteer’s knowledge.
2. Volunteer's Assumption of Risks, Limitation of Liability, Hold Harmless, and Indemnification Agreement
2.1. Safe Behavior around Horses
To promote the safety and welfare of volunteers, patients, animals, staff, and visitors, Volunteer agrees to strictly comply with all instructions, directives, policies, procedures, training, and safety guidance provided by Sundance personnel, instructors, supervisors, therapists, equine professionals, and other authorized representatives of Sundance. Volunteer acknowledges that horses are unpredictable animals and that failure to follow instructions may result in serious bodily injury, illness, property damage, or death to Volunteer or others.
Volunteer further agrees to become familiar with, and strictly adhere to, all Facility rules, barn rules, animal handling protocols, infection control requirements, patient interaction guidelines, emergency procedures, and safety standards, as amended from time to time by Sundance. Volunteer understands that compliance with such requirements is a condition of participation in Sundance's programs and activities.
Volunteer agrees to immediately follow any instruction to stop, modify, or refrain from any activity that Sundance personnel determine may present a safety, animal welfare, patient care, confidentiality, health, or operational concern. Volunteer acknowledges that Sundance reserves the right, in its sole discretion, to suspend, restrict, or terminate Volunteer’s participation in any activity or volunteer service for failure to comply with any instruction, rule, policy, procedure, or safety requirement.
2.2. Safety Attire
Sundance requires all individuals who ride, handle, work with, or are otherwise in the vicinity of horses at the Facility to wear properly fitted ASTM- and SEI-certified equestrian safety helmets, sturdy closed-toed boots (preferably with a heel), gloves, long pants, and long sleeves, as applicable to the activity being performed. Sundance may, in its sole discretion, require additional personal protective equipment or safety attire based on the nature of the volunteer assignment, the specific activity, environmental conditions, or safety considerations.
Volunteer agrees to comply with all safety equipment and attire requirements established by Sundance and acknowledges that Sundance may suspend, restrict, or terminate Volunteer’s participation in any activity if Volunteer fails or refuses to comply with such requirements.
Volunteer further acknowledges that horseback riding, horse handling, and work performed in proximity to horses involve significant inherent risks of serious bodily injury, paralysis, traumatic brain injury, and death. If Volunteer elects to participate in any activity without wearing required or recommended safety equipment, or otherwise fails to comply with Sundance's safety requirements, Volunteer knowingly and voluntarily assumes all additional risks arising from such noncompliance and accepts full responsibility for any resulting injury, death, loss, or damage sustained by Volunteer or caused to others, to the fullest extent permitted by applicable law.
2.3. Risk of Injury to or Death of Volunteer
Volunteer acknowledges and agrees that volunteering at Sundance and participating in equine-related activities, including but not limited to leading, sidewalking, grooming, handling, feeding, caring for, and working in proximity to horses, involves inherent and significant risks of serious bodily injury, illness, property damage, paralysis, and death.
Volunteer understands that horses are inherently unpredictable animals and may, without warning, bite, kick, buck, rear, bolt, spook, stumble, pull back, collide with persons or objects, or otherwise behave in ways that may cause injury or damage. Volunteer further acknowledges that the Facility and surrounding premises may contain inherent hazards, including uneven or slippery footing, holes, mud, rocks, obstacles, equipment, vehicles, animals, and other conditions that may result in injury.
TO THE FULLEST EXTENT PERMITTED BY LAW, AND ON BEHALF OF THE VOLUNTEER PARTIES, VOLUNTEER KNOWINGLY, VOLUNTARILY, AND EXPRESSLY ASSUMES ALL RISKS, KNOWN AND UNKNOWN, FORESEEABLE AND UNFORESEEABLE, ASSOCIATED WITH VOLUNTEER'S PRESENCE AT THE FACILITY AND PARTICIPATION IN ANY VOLUNTEER, EQUINE, ANIMAL CARE, OR RELATED ACTIVITY, INCLUDING RISKS ARISING FROM THE ORDINARY NEGLIGENCE OF SUNDANCE, VAN OGLE FORD LLC, AND THEIR RESPECTIVE MANAGERS, MEMBERS, DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, CONTRACTORS, VOLUNTEERS, SUCCESSORS, AND ASSIGNS (COLLECTIVELY, THE “RELEASED PARTIES”).
ACCORDINGLY, AND TO THE FULLEST EXTENT PERMITTED BY LAW, VOLUNTEER, ON BEHALF OF THE VOLUNTEER PARTIES, WAIVES, RELEASES, AND COVENANTS NOT TO ASSERT OR BRING ANY CLAIM AGAINST THE RELEASED PARTIES FOR ANY INJURY, DEATH, LOSS, DAMAGE, OR EXPENSE ARISING OUT OF OR RELATING TO VOLUNTEER'S PRESENCE AT THE FACILITY OR PARTICIPATION IN ANY VOLUNTEER OR EQUINE-RELATED ACTIVITY, EXCEPT TO THE EXTENT CAUSED BY A RELEASED PARTY'S GROSS NEGLIGENCE OR WILLFUL MISCONDUCT.
2.4. Risk of Loss of or Damage to Personal Property
Volunteer understands that bringing personal property—such as tack, personal equipment, bags, electronic devices, and vehicles—to any equine facility, including the Facility, is inherently risky. Property may be damaged or stolen by other people, rodents and other wild animals, horses, weather conditions, earthquakes, fire, or vehicle collisions. Volunteer understands and expressly assumes all risks of bringing personal property to the Facility, including the risk that the Released Parties may be negligent.
Volunteer agrees the Released Parties are not bailees with respect to personal property that Volunteer may bring to the Facility. Accordingly, on behalf of the Volunteer Parties, Volunteer agrees to hold the Released Parties harmless for loss of or damage to personal property. Volunteer understands and agrees to be solely responsible for safeguarding and insuring all personal property that Volunteer brings to the Facility.
2.5. Volunteer's Indemnification Agreement
Volunteer acknowledges and agrees that volunteering at Sundance and participating in equine-related activities, including but not limited to leading, sidewalking, grooming, handling, feeding, caring for, and working in proximity to horses, involves inherent and significant risks of serious bodily injury, illness, property damage, paralysis, and death.
Volunteer understands that horses are inherently unpredictable animals and may, without warning, bite, kick, buck, rear, bolt, spook, stumble, pull back, collide with persons or objects, or otherwise behave in ways that may cause injury or damage. Volunteer further acknowledges that the Facility and surrounding premises may contain inherent hazards, including uneven or slippery footing, holes, mud, rocks, obstacles, equipment, vehicles, animals, and other conditions that may result in injury.
TO THE FULLEST EXTENT PERMITTED BY LAW, AND ON BEHALF OF THE VOLUNTEER PARTIES, VOLUNTEER KNOWINGLY, VOLUNTARILY, AND EXPRESSLY ASSUMES ALL RISKS, KNOWN AND UNKNOWN, FORESEEABLE AND UNFORESEEABLE, ASSOCIATED WITH VOLUNTEER'S PRESENCE AT THE FACILITY AND PARTICIPATION IN ANY VOLUNTEER, EQUINE, ANIMAL CARE, OR RELATED ACTIVITY, INCLUDING RISKS ARISING FROM THE ORDINARY NEGLIGENCE OF SUNDANCE, VAN OGLE FORD LLC, AND THEIR RESPECTIVE MANAGERS, MEMBERS, DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, CONTRACTORS, VOLUNTEERS, SUCCESSORS, AND ASSIGNS (COLLECTIVELY, THE “RELEASED PARTIES”).
ACCORDINGLY, AND TO THE FULLEST EXTENT PERMITTED BY LAW, VOLUNTEER, ON BEHALF OF THE VOLUNTEER PARTIES, WAIVES, RELEASES, AND COVENANTS NOT TO ASSERT OR BRING ANY CLAIM AGAINST THE RELEASED PARTIES FOR ANY INJURY, DEATH, LOSS, DAMAGE, OR EXPENSE ARISING OUT OF OR RELATING TO VOLUNTEER'S PRESENCE AT THE FACILITY OR PARTICIPATION IN ANY VOLUNTEER OR EQUINE-RELATED ACTIVITY, EXCEPT TO THE EXTENT CAUSED BY A RELEASED PARTY'S GROSS NEGLIGENCE OR WILLFUL MISCONDUCT.
2.6.
3. Washington Equine Activity Statute
Sections 4.24.530 and 4.24.540 of the Revised Code of Washington are collectively known as the Washington Equine Activity Statute ("WEAS"). The WEAS operates to limit liability associated with certain types of equestrian activities.
3.1. Equine Activity: Volunteer acknowledges and agrees that all activities contemplated by and arising out of this Agreement are "equine activities" within the meaning of Section 4.24.530(2) of the WEAS.
3.2. Participant: Volunteer acknowledges and agrees that when engaged in the equine activities contemplated by or arising out of this Agreement, Volunteer is a "participant" in equine activities within the meaning of Section 4.24.530(4) of the WEAS and "engages in equine activity" within the meaning of Section 4.24.530(5) of the WEAS.
3.3. Equine Activity Sponsor and/or Professional: Volunteer acknowledges and agrees that the Released Parties are each an "equine activity sponsor" within the meaning of Section 4.24.530(3) of the WEAS and/or an "equine professional" within the meaning of Section 4.24.530(6) of the WEAS.
3.4. Limitations on Liability: In addition to the other limitations on liability contained in this Agreement, Volunteer acknowledges and agrees that the provisions of Section 4.24.540(1) of the WEAS shall apply to limit the Released Parties' liability with respect to Volunteer and the activities contemplated by and arising out of this Agreement.
4. Successors
The provisions of this Agreement shall extend to and be binding upon the parties and their respective legal representatives, heirs, successors, and assigns.
5. No Waiver
No action by either party shall be construed as a waiver of any of the terms and conditions of this Agreement. Any modifications to the parties' obligations hereunder must be made pursuant to Section 6.
6. Entire Agreement
This Agreement contains the entire agreement among the parties regarding Volunteer's participation and presence at the Facility. Any modifications or additions must be in writing and signed by all parties to the Agreement. No oral modifications will be considered part of the Agreement unless reduced to writing and signed by all parties.
7. Governing Law and Venue
This Agreement shall be governed by the laws of the State of Washington. The parties hereby agree any legal action under this Agreement must be brought in Pierce County, Washington.
8. Attorneys' Fees and Other Expenses
In any legal actions brought in connection with this Agreement, the prevailing party will be entitled to prompt payment of expenses from the other party(ies) following final adjudication in favor of the prevailing party. For the purposes of this section, "expenses" shall include the following costs actually incurred by the prevailing party: attorneys' fees, retainers, court costs, transcript costs, fees of experts, witness fees, travel expenses, duplicating costs, printing and binding costs, telephone charges, postage, delivery service fees, and all other disbursements.
9. Severability
If any provision of this Agreement or the application thereof to any person or circumstances is held invalid, such invalidity shall not affect other provisions or applications of this Agreement which can be given effect without the invalid provision or application. In lieu thereof, there shall be added a provision as similar in terms to such illegal, invalid, and unenforceable provision as may be possible and be legal, valid, and enforceable.
Volunteer Signature Block
BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE CAREFULLY READ, UNDERSTOOD, AND VOLUNTARILY AGREE TO ALL OF THE TERMS OF THIS ADULT VOLUNTEER RELEASE AND INDEMNIFICATION AGREEMENT.
Volunteer Signature: ____________________________________________________
Printed Name: _________________________________________________
Date: ________________________________________________________
Photo and Media Release:
The use of photographs and stories in Public Relations and Marketing Activities. Acknowledgement of this form will serve as agreement to the terms outlined below. This form is not required to be acknowledged. You have the right to revoke this Authorization at any time by sending a written revocation to the Practice via email at info@sundancehippotherapy.com.
• I hereby grant Sundance Circle Hippotherapy permission to use my likeness in a photograph/video in any and all of its publications, including website entries, without payment or any other consideration.
• I understand and agree that these materials will become the property of Sundance Circle Hippotherapy and will not be returned.
• I hereby irrevocably authorize Sundance Circle Hippotherapy group to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing Sundance Circle Hippotherapy Group’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.
• I hereby hold harmless and release and forever discharge Sundance Circle Hippotherapy Group from all claims, demands, and causes of action which I, my heirs, representative, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason this authorization.
Confidentiality and HIPAA Compliance:
This is a medical clinic and HIPAA Privacy Rules apply to all Sundance Circle Hippotherapy Volunteers and Staff. As a Volunteer, you are required to keep the identities of our patients confidential. Talking to friends and family about your experience at Sundance Circle is absolutely fine and we encourage you to share our organization with others; however, we ask that you refrain from using the names of patients or sharing private information under any circumstance.
Stories:
We would like to ask you to write about your gains with therapy. It is always great to hear about your success and to be acknowledged for what we do on a daily basis. We find that when physicians read about your experience at Sundance Circle Hippotherapy and the results you obtained, the impact is far greater than if we tell them in meetings or with other types of written materials. When the doctor reads your words, the doctor knows we are really helping people. On occasion, we do like to use patient Success Stories in our marketing materials. In order to use your story and disclose your name in this matter, we are required to obtain your authorization. I authorize Sundance Circle to use my Success Story in the following manner: The use of a portion of or my entire Story in marketing materials, such as brochures, pamphlets, Facebook, and website testimonials about Sundance Circle. The general public and physicians to whom Sundance Circle markets may read these marketing materials. By signing this form, I am stating I have reviewed this Authorization and agree to the Practice’s use and Disclosure of Protected health information for the purposes set forth within this authorization.
Volunteer Policies and Conduct Pledge:
These Volunteer Policies have been developed to provide guidelines about volunteer policies and procedures for Sundance Circle Hippotherapy. These policies are intended to ensure fair and consistent treatment of all volunteers. Volunteers at Sundance Circle Hippotherapy are vitally important and highly valued. You will have opportunities to meet the families of patients you work with, as well as helping in special events. We strive to give Volunteers the necessary training and support needed to assist our therapists and patients, care for the horses, and become capable representatives of Sundance Circle Hippotherapy. Additionally, these guidelines are subject to modification, amendment or revocation by at any time, without advance notice. The following guidelines outline what behavior is expected while performing as a Volunteer for Sundance Circle Hippotherapy:
• Complete all paperwork and liability release before working with horses and/or patients.
• Attend Volunteer training sessions.
• Be at least 16 years of age.
• Do not smoke or vape anywhere on the Sundance Circle Hippotherapy premises.
• Do not possess, use, or be under the influence of alcohol and/or illegal drugs while in any Sundance Circle Hippotherapy class or while volunteering at any Sundance Circle Hippotherapy event, meeting, or activity.
• Do not bring any pets or outside animals on the Sundance Circle Hippotherapy premises, service animals are exceptions.
• Do not use obscene or discriminatory language in any Sundance Circle Hippotherapy class, event, meeting, or activity.
• Dress conservatively and appropriately when on Sundance Circle Hippotherapy premises and while volunteering for a Sundance Circle Hippotherapy event.
• Handle therapy horses as you have been trained by Sundance Circle Hippotherapy, which includes never to strike, hit, slap, jerk, or discipline the horses in any manner.
• Do not enter horses pastures or stalls if you are not assigned to clean them or retrieve a horse from them.
• Volunteers who require the use of mobility devices are not allowed to lead horses under any circumstances.
• Report the mistreatment of the horses to Sundance Circle Hippotherapy staff immediately.
• Respect individual confidentiality, rights, safety, and property of others whether they are staff, patients, or fellow volunteers.
• Do not discriminate in any practices based on race, religion, color, national origin, political association, sexual orientation, age, mental condition, or disability.
• Always inform the Volunteer Coordinator if there is a change of address, phone number or emergency contact.
• Inform staff immediately if you have an injury or condition that would compromise safety to yourself, the patient, or others during your scheduled volunteer time.
• Silence cell phones to avoid being distracted while with a patient or working in the barn. Never engage in cell phone use while “on duty”.
• Report horse behaviors which are out of the norm to the Barn Staff before you leave the Sundance Circle Hippotherapy property for the day.
No Trespassing Policies:
• Purpose: To ensure the safety, privacy, and well-being of our patients, families, staff, volunteers, and therapy horses, Sundance Circle Hippotherapy maintains a strict No Trespassing Policy. Because we operate a specialized equine-assisted therapy program, access to the property is limited and controlled.
• Authorized Access Only. The following individuals are permitted on the premises: Scheduled patients and active therapy participants, Parents/guardians and family members of scheduled patients, Registered and approved volunteers, Authorized visitors, Employees and contracted professionals, Pre-approved vendors and service providers
• All authorized individuals must: Remain in designated areas only, Follow all safety and supervision rules, Comply with staff instructions at all times
• Definition of Trespassing: Trespassing includes, but is not limited to: Entering the property without prior authorization, Remaining on the premises without a scheduled appointment or approval, Entering restricted areas (barn, paddocks, arena, feed room, tack room, storage areas, staff-only areas) without permission, Interfering with therapy sessions, horses, staff, or participants, Visiting outside of posted operating hours without permission, The facility is private property and not open to the general public.
• Restricted Areas: For safety reasons, the following areas are restricted unless directly supervised or properly trained and authorized: Horse stalls and pastures, Arena during active sessions, Equipment, feed, and tack areas, Staff offices, Children must be supervised at all times and are not permitted to roam the property.
• Visiting Hours: Access is permitted by appointment only during scheduled therapy sessions, volunteer shifts, or approved events. There is no public access for casual visits, horse viewing, photography, or recreational riding unless authorized in advance.
• Enforcement: Unauthorized individuals will be asked to leave immediately. The facility reserves the right to deny access to anyone at its discretion for safety or operational reasons.
• Failure to comply may result in: Removal from the premises, Suspension of volunteer or participant privileges, Notification of law enforcement, Issuance of a formal trespass notice
• Safety & Animal Welfare Considerations. As a working therapy facility with large animals: Horses may react unpredictably to unfamiliar people, Loud noises and unauthorized interaction can endanger participants, Maintaining controlled access protects the physical and emotional safety of our patients and therapy animals.
