WHEREAS, Sundance Circle Hippotherapy LLC (“Sundance”) provides hippotherapy services at an equestrian facility (the “Facility”) located at 16516 92nd St East, Sumner, Washington 98390; and

WHEREAS, in consideration of Sundance permitting Patient to visit the Facility and participate in such activities, Patient agrees to release and indemnify Sundance and certain other parties from all claims as set forth in this agreement.

NOW, THEREFORE, Patient agrees as follows:

Patient’s Representations and Warranties. Patient makes each of the following representations and warranties on behalf of Patient and Patient’s heirs, guardians, successors, assigns and legal representatives (collectively, the "Patient Parties"):

Patient is at least 18 years of age.
Patient does not have any physical or mental conditions that may prevent Patient from safely participating in horse-related activities in general and hippotherapy in particular.
Patient is not under the influence of alcohol or drugs at the time Patient enters into this Agreement.
Patient will not be under the influence of alcohol or drugs at any time while Patient is present at the Facility.

Patient’s Assumption of Risks, Limitation of Liability, Hold Harmless and Indemnification Agreement.

Safe Behavior around Horses. To help prevent injuries and/or death, Patient agrees to follow carefully any instructions that may be given to Patient by Sundance personnel and others at the Facility regarding horse behavior and handling. Patient agrees to follow carefully all of Facility’s barn rules.

Safety Attire. Sundance highly recommends that all persons riding or handling horses at the Facility wear an ASTM- or SEI-certified equestrian safety helmet, heeled boots, gloves, long sleeves and long pants. Sundance may also recommend additional safety attire. Should Patient fail to wear a helmet or other safety attire while riding or handling horses at the Facility, Patient agrees on behalf of the Patient Parties to assume the increased risk of injury and death resulting from such failure.

Risk of Injury to or Death of Patient. Patient understands that horse-related activities, including hippotherapy, are inherently dangerous and expressly assumes the risks associated with participating in hippotherapy provided by Sundance at the Facility, including riding, handling and caring for horses. Patient understands that horses are inherently unpredictable animals and even the most docile and well-trained horse may occasionally bolt, spook, buck, rear, bite, kick, pull back or otherwise act in such a way that may injure Patient or others. The Facility may contain defects. For example, footing at the Facility, including paddock, round pen and arena footing, can contain holes, rocks, uneven portions or otherwise be unpredictable. And as at any equestrian facility, there are non-equine-related risks of visiting the Facility such as tripping and falling. On behalf of the Patient Parties, Patient expressly assumes all risks of engaging in hippotherapy and other horse-related activities at the Facility, including the risk that Sundance and its managers, members, employees, independent contractors and agents; and Van Ogle Ford LLC and its managers, members, employees, agents and independent contractors (collectively, the “Released Parties”) may be negligent. Accordingly, on behalf of the Patient Parties, Patient agrees not to sue the Released Parties or otherwise make a claim against such parties in connection with any injury or death occurring in connection with Patient’s presence at the Facility.

Risk of Loss of or Damage to Personal Property. Patient understands that bringing personal property, such as tack, equipment and vehicles, to any equine facility, including the Facility, is inherently risky. For example, property may be damaged or stolen by other people, rodents and other wild animals, horses, weather conditions, earthquakes, fire or vehicle collisions. Patient understands and expressly assumes all risks of bringing personal property to the Facility, including the risk that the Released Parties may be negligent. Patient agrees the Released Parties are not bailees with respect to personal property that Patient may bring to the Facility. Accordingly, on behalf of the Patient Parties, Patient agrees to hold the Released Parties harmless for loss of or damage to personal property. Patient understands and agrees to be solely responsible for safeguarding and insuring all personal property that Patient brings to the Facility.

Patient’s Indemnification Agreement. Patient agrees to defend, indemnify and hold the Released Parties harmless against all claims, demands, and causes of action, including costs and attorneys' fees, directly or indirectly arising from any action or other proceedings brought by or prosecuted for the benefit of any of the Patient Parties or brought by others against the Released Parties in connection with Patient’s presence at the Facility, any family members or guests of Patient, or any action or inaction taken by Patient.

Limitation of the Released Parties’ Liability. In addition to the other provisions of this Section 2, Patient agrees upon behalf of the Patient Parties that the Released Parties’ liability pursuant to this Agreement shall not exceed the aggregate amount paid by Patient to Sundance.

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.

Equine Activity. Patient acknowledges 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.

Participant. Patient acknowledges and agrees that when engaged in the activities contemplated by or arising out of this Agreement, Patient 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.

Equine Activity Sponsor and/or Professional. Patient 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.

Limitations on Liability. In addition to the other limitations on liability contained in this Agreement, Patient 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 Patient and the activities contemplated by and arising out of this Agreement.

Successors. The provisions of this Agreement shall extend to and be binding upon the parties and their respective legal representatives, heirs, successors and assigns.

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.

Entire Agreement. This Agreement contains the entire agreement among the parties. 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.

Governing Law and Venue. This Agreement shall be governed by the laws of Washington. The parties hereby agree any legal action under the Agreement must be brought in Pierce County, Washington.

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.

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.

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.

Photos/Media

• 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.

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.

Also, 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.