MIKE AND BRENDA MCKINLEY, DBA. MCKINLEY’S HARMONY ACRES
PREMISES OWNERS NAME, hereinafter know as “THIS STABLE”
64247 LIBRARY ROAD, CASSOPOLIS, MI 49031
LOCATION OR ADDRESS OF STABLE
READ CAREFULLY AND COMPLETE ALL SECTIONS BEFORE SIGNING
MICHIGAN WARNING
Under the Michigan equine activity liability act, and equine professional is not liable for an injury to
or the death of a participant in an equine activity resulting from an inherent risk of the equine activity.
You are responsible for damage caused by you or your animals. We do not provide insurance for you or your animals. You
are responsible for insurance, if you so desire. The Stable is not responsible for damage or replacement of your tack or
vehicles, death, injury, veterinary services or replacement cost of your animals. No dangerous animals (it is the decision
of the Stable to determine what is dangerous). Your animals are your responsibility and you are responsible for their
actions and/or damage. ALL MINORS UNDER 18 ARE REQUIRED TO WEAR A HELMENT WHEN RIDING. No smoking in
any of the barns or arena. No glass bottles in the barns or arena. All pets must be leashed at all times. All children must
be attended and not running through barns, in paddocks, pastures or climbing in hay. Pick up after yourself. Muck up after
your horses.
SIGNER STATEMENT OF AWARENESS
I/WE THE UNDERSIGNED REPRESENT THAT I/WE HAVE READ AND DO UNDERSTAND THE
FOREGOING AGREEMENT, LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT. I/WE
ATTEST THAT ALL FACTS ARE TRUE AND ACCURATE. I AM SIGNING THIS WHILE OF SOUND MIND
AND NOT SUFFERING FROM SHOCK, OR UNDER THE INFLUENCE OF ALCOHOL OR INTOXICANTS.
X____________________________________________________________________________________________
Responsible Party’s Signature Date
X____________________________________________________________________________________________
PRINT YOUR NAME CLEARLY ____ CHECK HERE IF SAME AS PERSON RIDING
_____________________________________________________________________________________________
Address City State Zip
_____________________________________________________________________________________________
Phone Email Address
_____________________________________________________________________________________________
Emergency Contact Name - Who Could We Call For You? Phone
_____________________________________________________________________________________________
1. RIDER'S NAME (if different than above) Age (if under 18)
_____________________________________________________________________________________________
2. ADDITIONAL RIDER'S NAME Age (if under 18)
PREMISES OWNERS NAME, hereinafter know as “THIS STABLE”
64247 LIBRARY ROAD, CASSOPOLIS, MI 49031
LOCATION OR ADDRESS OF STABLE
READ CAREFULLY AND COMPLETE ALL SECTIONS BEFORE SIGNING
MICHIGAN WARNING
Under the Michigan equine activity liability act, and equine professional is not liable for an injury to
or the death of a participant in an equine activity resulting from an inherent risk of the equine activity.
You are responsible for damage caused by you or your animals. We do not provide insurance for you or your animals. You
are responsible for insurance, if you so desire. The Stable is not responsible for damage or replacement of your tack or
vehicles, death, injury, veterinary services or replacement cost of your animals. No dangerous animals (it is the decision
of the Stable to determine what is dangerous). Your animals are your responsibility and you are responsible for their
actions and/or damage. ALL MINORS UNDER 18 ARE REQUIRED TO WEAR A HELMENT WHEN RIDING. No smoking in
any of the barns or arena. No glass bottles in the barns or arena. All pets must be leashed at all times. All children must
be attended and not running through barns, in paddocks, pastures or climbing in hay. Pick up after yourself. Muck up after
your horses.
SIGNER STATEMENT OF AWARENESS
I/WE THE UNDERSIGNED REPRESENT THAT I/WE HAVE READ AND DO UNDERSTAND THE
FOREGOING AGREEMENT, LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT. I/WE
ATTEST THAT ALL FACTS ARE TRUE AND ACCURATE. I AM SIGNING THIS WHILE OF SOUND MIND
AND NOT SUFFERING FROM SHOCK, OR UNDER THE INFLUENCE OF ALCOHOL OR INTOXICANTS.
X____________________________________________________________________________________________
Responsible Party’s Signature Date
X____________________________________________________________________________________________
PRINT YOUR NAME CLEARLY ____ CHECK HERE IF SAME AS PERSON RIDING
_____________________________________________________________________________________________
Address City State Zip
_____________________________________________________________________________________________
Phone Email Address
_____________________________________________________________________________________________
Emergency Contact Name - Who Could We Call For You? Phone
_____________________________________________________________________________________________
1. RIDER'S NAME (if different than above) Age (if under 18)
_____________________________________________________________________________________________
2. ADDITIONAL RIDER'S NAME Age (if under 18)
| LIABILITY WAIVER |
