2. One (1) day pass - $15
   Please note non-members must be with a GHPEC member to participate in equestrian activities.
4. Date Requested for Use*
   Date Requested for Use
5. Sponsoring GHPEC Member*
7. Application must be completed and processed prior to using Equestrian Center
   Please complete this information for the individual applying for a one day pass:
9. Name:*
10. Address:*
12. City:*
13. State:*
14. Zipcode:*
16. Primary Phone:*
17. Emergency Contact Phone:
18. Email Address:*
20. EQUINE ACTIVITY LIABILITY RELEASE, WAIVER OF RIGHT TO SUE AND ASSUMPTION OF ALL RISKS
    The Equestrian Committee requires that all day pass users read and accept the following agreement before processing your rental. Person submitting waiver must be over the age of 18.
22. This Equine Activity Liability Release, Waiver of Right to Sue and Assumption of all Risks Agreement ("this Agreement") is hereby given by the undersigned to the "Roanoke County Board of Supervisors, Roanoke County Department of Parks and Recreation, and Green Hill Park Equestrian Center Advisory Committee," each an equine activity sponsor and/or an equine activity professional (the "sponsor/professional") and to the sponsor/professional as agent for and for the benefit of each owner of land upon which an equine activity to which the Agreement relates is conducted ("owner") and each partner, officer, agent, employee, director, shareholder, member heir, personal representative, successor and assign of the sponsor/professional and of each owner (who shall be included within the words "sponsor/professional" or "owner" as their relationships may determine) provides as follows:
24. In consideration for the opportunities provided by the sponsor/professional and each owner to the undersigned "participant" (including any minor participants for whom he signs this Agreement) for the enjoyment of equine activities as a participant, the undersigned "participant" (including any minor participant for whom he signs this Agreement) hereby agrees as follows:
    .
26. 1) This Agreement is given under the Virginia Equine Activity Liability Act (Code of Virginia 3.1-796.130 et seq.) as it may now provide or be hereafter amended (the "Act"). All terms defined by the Act shall have the same meaning herein, and the Act is hereby incorporated in this Agreement by reference. This Agreement shall be so construed as to provide to the sponsor/professional the fullest protection of a release, waiver of right to sue and assumption of all risks which is afforded to the sponsor/professional by the Act
28. 2) All pronouns shall be construed to include the masculine, feminine or neuter as well as the plural or singular, as may be appropriate to facilitate the construction of this Agreement in the light of the facts presented.
30. 3) The participant hereby acknowledges that he has full and complete notice and understanding of the Act and of all the risks inherent in equine activities which may cause, contribute to or result in the death or personal injury of the participant or damage to the participant's property (the "Risks"), including, but not limited to: (i) the propensity of an equine to behave in dangerous ways or to trip and/or fall; (ii) the ability of anyone whomsoever to predict or foresee an equine's reaction to excitement, weather conditions, sound, movements, objects, persons, animals, reptiles, birds or insects, and the effects of such reactions; (iii) the hazards of surface or subsurface conditions, including but not limited to objects or conditions on, under or protruding from the surface, both latent and patent; (iv) the hazards which rocks, cliffs, hills, fences, trees, stumps, logs, bridges, ditches and other debris and obstacles, and any equine activity in connection therewith, may foreseeable or unforeseeably present; (v) the dangers and risks of tack or harness slipping or breaking for whatever reason; (vi) the dangers and risks of becoming entangled in tack, harness, or vehicles used in an equine activity, (vii) the risks of falling from or otherwise becoming unstable on an equine or a vehicle used in an equine activity for any reason whatsoever or for no identifiable reason and (viii) any negligent act or omission by the sponsor/professional or any owner which causes or results in the death or personal injury of the participant or damage to the participant's property.
32. 4) The participant hereby RELEASES and WAIVES all rights which he may have or hereafter have against the sponsor/professional and each owner for death, personal injury or property damage which is in any way associated with the Risks; he does hereby WAIVE his right to sue or to bring any action against the sponsor/professional or any owner in connection therewith; he agrees to INDEMNIFY and DEFEND the sponsor/professional and each owner from and to HOLD the sponsor/professional and each owner HARMLESS against any such suit or action, and he hereby expressly ASSUMES ALL RISKS AND DANGERS of death, personal injury and property damage which are in any way associated with the Risks enumerated in paragraph 3, above.
34. 5) The participant hereby authorizes and consents to any emergency medical care which may at the time appear reasonably appropriate under the circumstances as a result of injury or sickness caused by or incurred in the course of an equine activity.
36. 6) The Agreement shall remain valid and in full force and effect from and after the date opposite the signature of the participant until expressly revoked by the participant in a written notice personally delivered to the sponsor/professional.
38. 7) To the extent possible, this Agreement shall be construed in such manner as will render it, and each provision of it, fully enforceable; but if any provision of this Agreement shall be unenforceable, such provision (or so much thereof as is unenforceable) shall be deleted and the remainder of this Agreement shall continue in full force and effect.
40. 8) If this Agreement is executed by the undersigned participant for and on behalf of a minor participant named below, the undersigned participant hereby warrants and represents that he is in fact the legal parent or guardian of such minor, with full rights of custody and control; that this Agreement is given on behalf of and is intended to be binding upon said minor participant, his heirs, personal representatives, successors and assigns; and the undersigned participant further agrees that this Agreement shall also be as fully binding on the undersigned participant as if it were entered into solely on his own behalf.
42. 9) This Agreement shall be binding upon the heirs, personal representatives, successors and assigns of the participants.
44. BY SUBMITTING THIS FORM, I DECLARE THAT I HAVE FULLY READ AND FULLY UNDERSTAND THE FOREGOING EQUINE LIABILITY RELEASE WAIVER OF RIGHT TO SUE AND ASSUMPTION OF ALL RISKS. I HAVE CONSULTED AND RELIED UPON MY OWN ADVISORS ON ALL QUESTIONS IN CONNECTION THEREWITH, AND I HAVE NOT RELIED UPON THE SPONSOR/PROFESSIONAL OR ANY OWNER FOR ANY ADVICE OR EXPLANATION IN CONNECTION THEREWITH.
45. Application Date (today):*
    Application Date (today):
47. If agreeing for a minor participant, please list the name and age in the space below:
49. By submitting this form, you are agreeing to the waiver above.
    Please note that your reservation is not complete until payment is made. For questions please call (540) 387-6078 ext. 8267 or email dreid@roanokecountyva.gov.
51. After submitting application please send payment to:
    Roanoke County Parks Recreation and Tourism - 1206 Kessler Mill Rd Salem VA 24153
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field