Liability Release

I, the undersigned, hereby agree for myself and my heirs to fully and forever release and discharge the Gold Dust Arena Committee and it’s Board Members thereof from any Claims, demands, damages, rights of action of or cause of damage or loss on account of persons or property resulting from or which may result either directly or indirectly from the participation and use of the facilities or equipment of Gold dust rodeo. I hereby agree that I am using these facilities at my own risk and I assume full responsibility for such use and for any results thereof. In addition I/We agree to assume all responsibility and risk from participation in the equine activities. I fully understand that Horseback riding is a risk sport and engage in the sport at my own risk. I shall abide by all the rules of the Gold Dust Rodeo Association.

Date:_______________Signature:____________________________________________

Emergency Contact: ________________________________ Phone:__________________

Insurance Company: ________________________________ Policy #________________

Physician: _______________________________________ Phone: __________________

Allergies: ________________________________________________________________

Medication currently being taken: ____________________________________________

Signature: _______________________________________ Date: __________________