Heritage Ranch Day-Trippers Participant Release Form

Form to be completed, signed, dated, and returned to Carolyn Hollingsworth, 1356 Ranch House, prior to commencement of each trip.

Trip: _____________________________　　　　　　　Trip date: _________________________________

Name: ____________________________　　　　 　   Nickname: ________________________________

Address: __________________________　　　　　　　Home Phone: _____________________________

E-mail address: _____________________               Cell Phone: ______________________________

Emergency contact: __________________　　　　　　 Phone: ___________________________________

I, (name) _____________________________, understand that neither Heritage Ranch, Heritage Ranch Day-Trippers Club, nor any of the Club's officers or employees may be held responsible in any way for any injury, death or other damages to me or my family or my heirs due to my elective participation in this trip, or as a result of the negligence of any party, including the released parties, whether passive or active. By signing this release, I certify that I am aware that travel in any form, by car, bus or any other method, may be risky and I assume all risks involved.

I understand that travel can include physically strenuous activity and that I will exert myself during the trip. If I am injured during the trip, I assume the risk of injury and will not hold Heritage Ranch, Heritage Ranch Day-Trippers nor their officers or employees responsible in any way.

I am currently in good health, am not oxygen dependent, and will make known any pre-existing conditions that will require specific accommodations for my participation in the trip.

Being of lawful age and fully competent, I acknowledge having read all previous statements, understand the risks in traveling, and am aware of the legal consequences of signing this release. I understand and agree that this release is legally binding and will preclude me from recovering monetary damages from Heritage Ranch, Heritage Ranch Day-Trippers, officers and employees whether named or not, for personal injury, property damage, and wrongful death caused by negligence or product liability.

Signed: _____________________________________________ Date: _______________________

Received by: ________________________________________ Date: ________________________