Christine Marie’s STAR Riders
CONSENT FORM

RELEASE AND WAIVER:  I ________________________________, hereby volunteer to participate in activities provided by Christine Marie’s STAR Riders-Special Therapeutic and Recreational Riding Program.
 The undersigned hereby agrees to release and discharge Christine Marie’s STAR Riders, its officers, agents, employees and volunteers, the City of Marina and the Marina Equestrian Association from all claims, demands, actions or causes of action, which the participant, his or her personal representatives, heir and next of kin, may or might have against Christine Marie’s  STAR Riders, its officers, agents, employees and volunteers or any owner of any horse , the City of Marina, and Marina Equestrian Association on account of injury to or death of the participant, or damage to the property of the participant arising out of their participation in sponsored activities. The undersigned further agrees to indemnify and hold harmless Christine Marie’s STAR Riders from any loss, liability, and damage or costs that may be incurred due to the acts of the participant during their participation in sponsored activities.

PHOTOGRAPHIC RELEASE:  The undersigned does hereby give consent to Christine Marie’s STAR Riders to be photographed or in a video without limitation, to use such pictures and /or video stories in connection with any of the work of said Christine Marie’s STAR riders without consideration of compensation of any kind, and does hereby release said Christine Marie’s STAR Riders from any claims whatsoever which might arise in said regard.      
MEDICAL RELEASE:  In the event that an emergency should arise while the above named person is participating in a sponsored activity, an effort will be made to contact the parents/guardian if under age.  If they cannot be reached, the undersigned authorizes Christine Marie’s STAR Riders employees or volunteers to select and designate nurses, physicians and surgeons to furnish such medical and/or surgical care as, is in the judgment of a physician and/or surgeon holding a physician's certificate issued by the Board of Medical Examiners of the State of California, may be needful and proper. The undersigned absolves the Christine Marie’s STAR Riders, its employees and volunteers, and nurses, physicians, and surgeons selected and designated by them, from any and all liability for their acts rendered in good faith.
COMMUNITY CONSENT:  The undersigned further agrees to give permission for the participant to go into the community on STAR Riders sponsored activities. Transportation may be by walking, public transportation or private automobile.  Staff members will supervise according to the participant's ability to be independent and safe. 

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Signature                                                                                             Date 
PARENTS' / GUARDIANS' SIGNATURE REQUIRED OR RESPONSIBLE PARTY 
If under age to sign a release