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Insurance Waivers

Please note that as we have changed insurance, new waivers must be signed.  Please print off insurance waivers and send them in with your membership, or just send them in alone!

There are two ways in which you can print off your insurance waiver. If neither seems to work for you, proceed to option #3.

1) Click on this link and then download it to your computer.  Then print it off and mail it in . Member_Ins_Waiver.pdf

2) You should be able to copy the insurance waiver below, by highlighting the form below, right clicking, clicking on copy and then pasting it into n word document you are able to print from.

3) If you are unable to do this please contact our Secretary, Yvonne Hussey (250-843-7622), she will be able to mail you a copy! 




Insurance Waivers

to be mailed to:

PCBRA

c/o Yvonne Hussey

Box 146 Arras, BC

V0C 1B0

 

EQUESTRIAN ACTIVITIES

WAIVER AND RELEASE OF LIABILITY

 

 

In consideration of being allowed to participate in any way in the Peace Country Barrel Racing

Association, related events and Peace Country Barrel Racing Association activities, the undersigned acknowledges, appreciates, and agrees that:

 

 

1.         The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

 

2.         I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

 

3.         I willingly agree to comply with the stated and customary terms and conditions for participation.  If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

 

4.         I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Peace Country Barrel Racing Association,

their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

 

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

 

 

 

X    ____________________________________    Date Signed:  _______________________

             PARTICIPANT’S SIGNATURE

 

 

X    ____________________________________    

            WITNESS

 

 

 

FOR PARTICIPANTS OF MINORITY AGE

(UNDER AGE 18 AT TIME OF REGISTRATION)

 

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above.

 

 

X_________________________________________         ____________________________               PARENT/GUARDIAN’S SIGNATURE                                      EMERGENCY PHONE NUMBER

 

 

X  ________________________________________              ___________________________

          WITNESS                                                                            PRINT WITNESS NAME


 
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