Liability Waiver Liability Release and Indemnification Agreement Liability Release and Indemnification Agreement PLEASE READ CAREFULLY AND COMPLETE ALL SECTIONS PRIOR TO SIGNING The undersigned Visitor (the “Visitor”) has requested that Hope Land LLC, a Maine limited liability company (“Hope Land”), Broadview Farm LLC, a Maine limited liability company, (“BF”), Reno’s Barn LLC, a Maine limited liability company (“RB”), Horses with Hope LLC, a Maine limited liability company (“HWH”), Blue Moon Landmark, LLC, a Maine limited liability company (“BML”), Carolina Fields, LLC, a Maine limited liability company (“CF”), Reno’s Blue Moon, LLC, a North Carolina limited liability company (“RBM”), and/or Sam’s Place, LLC, a North Carolina limited liability company (“SP”), Tannetta van Vlissingen (“van Vlissingen”), and Michael John Bissict (“Bissict”) (Hope Land, BF, RB, HWH, BML, RBM, SP, van Vlissingen and Bissict, together with any lessees, contractors, and invitees, being jointly and severally referred to as “HL”) permit Visitor to be present on any HL property at any of the addresses listed in Exhibit A attached hereto (the “Property”) and observe horses or other equine species (“Horses” and, each individually, a “Horse”), which also may result in the Visitor having contact with dogs (“Dogs” and, each individually, a “Dog”) at the Property (each instance, a “Visit”). In consideration of HL and any trainers, managers, members, employees, agents, successors, assigns, premises owners, and/or others acting on behalf of HL or owners allowing the Visitor to visit the Property, the Visitor, for himself, herself, or itself and on behalf all minor children and/or legal wards, heirs, administrators, personal representatives, and assigns of the Visitor, hereby agrees to the terms of this Liability Release and Indemnification Agreement (“Agreement”) and acknowledges the inherent risks described below. The Visitor acknowledges that this Agreement is limited to any Visit on the Property, and does not authorize the Visitor to participate in any activities, including the riding of any Horse, on the Property. If the Visitor would like to participate in any activities on the Property, including the riding of any Horse, the Visitor must enter into a separate Liability Release and Indemnification Agreement related thereto. For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, intending to be legally bound, the undersigned acknowledges and agrees as follows: SECTION 1. Visitor Information The undersigned, including the parent or legal guardian of a minor (the “Visitor”), voluntarily agrees to visit the Property: Name * First Name Last * Last Name Accident/Medical Insurance The Visitor hereby consents to receive medical treatment deemed necessary if Visitor is injured or require medical attention during any Visit. The Visitor hereby acknowledges and agrees that should medical treatment be required, the Visitor and/or his, her or its medical insurance company shall pay for all expenses incurred and hereby releases, forever discharges, and hold harmless HL from any claim based on such treatment or other medical services. Do you carry medical insurance? * Yes No My medical insurance company is: * My policy number is: * Emergency Contact Information In the event of an emergency involving the Visitor, HL is authorized to contact the following individual(s): Full Name * Phone * Relationship * SECTION 2. Assumption of Risk The Visitor hereby acknowledges that any Visit to the Property, which may include being in the presence of any Horse or Dog, involves inherent risks, conditions, and dangers regardless of all feasible safety measures that may be taken by HL, the Visitor, or any participant. These inherent risks include, but are not limited to the propensity of a Horse or Dog to behave in ways that may result in injury, harm, death, or loss to persons on or around the Horse or Dog; the unpredictability of a Horse’s or Dog’s reaction to sounds, sudden movement, unfamiliar objects, persons, or other animals; hazards such as surface and subsurface conditions; collisions with other animals or objects; and the potential of a Visitor to act in a negligent manner that may contribute to injury to the Visitor, or others. Horses are present on the Property. Horses are approximately 5 to 15 times larger, 20 to 40 times more powerful, and 3 to 4 times faster than a human. If a Horse is frightened or provoked, it may divert from its training and act according to its natural survival instincts that may include, without limitation: stopping short, spinning around, changing directions or speed at will, shifting its weight, bucking, rearing, kicking, biting, and/or running from danger. The Visitor acknowledges that the Horse may do any of the foregoing things without warning and even if the particular Horse has no history of inflicting injury. Dogs are present on the Property. If a Dog is frightened or provoked, it may act according to its natural survival instincts that may include, without limitation, biting, growling, scratching, and/or running from danger. The Visitor acknowledges that the Dog may do any of the foregoing things without warning and even if the particular Dog has no history of inflicting injury. The Visitor is aware and understands that any Visit to the Property is potentially dangerous and may involve the risk of personal or psychological injury, pain, suffering, temporary or permanent disability, death, property damage, and/or financial loss. The Visitor acknowledges that any injuries that the Visitor sustains may result from or be compounded by the actions, omissions, or negligence of HL, including negligent emergency response or rescue operations of HL. Notwithstanding the risk, the Visitor acknowledges that the Visitor is knowingly and voluntarily visiting the Property with an express understanding of the danger involved and hereby agrees to accept and assume any and all risks of injury, disability, death, and/or property damage arising from the Visit, whether caused by the ordinary negligence of the company or otherwise. The Visitor further acknowledges that this Agreement lists just some of the many risks associated with the Visit and agrees to assume the other inherent risks not specifically indemnified herein. The Visitor acknowledges and agrees that he or she is not relying on HL or others acting on behalf of HL to identify all risks associated with the Visit in this document or at any time, now or in the future. SECTION 3. Liability Release In consideration of HL and any trainers, managers, members, employees, agents, successors, assigns, premises owners, and/or others acting on behalf of HL or owners allowing the Visitor to visit the Property, the Visitor, for himself, herself, or itself and on behalf all minor children and/or legal wards, heirs, administrators, personal representatives, and assigns of the Visitor, hereby agrees to release, hold harmless, and discharge HL and any of its affiliates, members, managers, employees, agents, successors and assigns (collectively, the “Releasees”), from and against any and all claims, demands, and causes of action, whether the same shall be known or unknown, anticipated or unanticipated, arising out of or in connection with any bodily injury, property damage, economic loss, or other damages of any kind or nature (together, “Damages”) sustained by the Visitor as a result of the negligence or other legal liability of the Releasees, and, except in the event of the gross negligence or intentional misconduct of HL, the Visitor, for himself, herself, or itself and on behalf of all minor children and/or legal wards, heirs, administrators, personal representatives, and assigns of the Visitor, hereby agrees not to bring or assert in any forum or jurisdiction any such claim, demand, or cause of action for Damages, against any Releasee or Releasees, sustained as a result of any Visit to the Property with the Releasees. The Visitor acknowledges that if Visitor places himself, herself, or itself in an unauthorized area and in immediate proximity to any Horse, the Visitor agrees that the release of liability of the North Carolina Equine Liability and Farm Animal Activity Act, which notice is included below, shall be applicable. SECTION 4. Indemnification The Visitor agrees to defend, indemnify, and hold harmless the Releasees from and against any and all liability, losses, damages, demands, claims, causes of action, judgments, settlements, interest, awards, penalties, fines or expenses (including reasonable attorneys’ fees and costs) by third persons (including, without limitation. relatives, guests, other participants, spectators, and visitors) as a result of Damages that the Visitor causes, directly or indirectly, while present on the Property, at any time and at any location. SECTION 5. Presence on the Property The Visitor agrees to be fully responsible for their, his or her own safety at all times while present on the Property. The Visitor acknowledges and agrees that it is Visitor’s sole responsibility to ensure that the proper protective gear is worn while present on the Property. The Visitor assumes all responsibility for the determination of what protective gear for Visitor present on the Property is necessary or appropriate. The Visitor further acknowledges that prior to the Visit, that the Visitor has inspected his, her or its equipment that is necessary or appropriate for the Visit. The Visitor agrees that he, she, or it will follow all instructions of any onsite property manager or other representative or agent of HL while on the Property. The Visitor further agrees that he, she or it will remain within authorized areas and not in immediate proximity to any Horse. SECTION 6. Severability If any provision or provisions of this Agreement is held to be invalid, illegal, unenforceable, or in conflict with the law of any jurisdiction, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby. SECTION 7. Governing Law; Agreement to Jurisdiction This Agreement, and all matters arising herefrom, shall be governed by and construed in accordance with the internal laws of the State of North Carolina without giving effect to the conflict of law provisions thereof to the extent such provisions would require or permit the application of the laws of any jurisdiction other than the State of North Carolina. The sole and exclusive jurisdiction for any legal suit, action, proceeding or dispute arising from or relating to this Agreement shall be instituted in the federal courts of the United States of America or the courts of the State of North Carolina in each case located in the city of Raleigh and county of Wake, North Carolina. SECTION 8. Miscellaneous This Agreement constitutes the sole and entire agreement of HL and the Visitor with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. This Agreement is binding on and shall inure to the benefit of HL and the Visitor and any respective heirs, successors, and assigns. HL and the Visitor agree that this document consists of eight (8) pages, with each page requiring the initials of the Visitor. The signatories on pages 6-7, the signature pages, acknowledge full understanding and agreement of this document by all parties. WARNING Under North Carolina law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina General Statutes. I/WE, THE UNDERSIGNED, REPRESENT AND WARRANT THAT I/WE HAVE READ AND UNDERSTAND THE FOREGOING AGREEMENT AND THAT BY SIGNING THIS AGREEMENT I/WE UNDERSTAND THAT I/WE AM GIVING UP CERTAIN RIGHTS, INCLUDING, WITHOUT LIMITATION, THE RIGHT TO SUE TODAY OR IN THE FUTURE FOR DAMAGES SUSTAINED AS A RESULT OF THE NEGLIGENCE OR OTHER LEGAL LIABILITY OF HL. I/WE HAVE READ AND UNDERSTAND THE NORTH CAROLINA EQUINE LIABILITY AND FARM ANIMAL ACTIVITY ACT NOTICE SET FORTH ABOVE. I/WE ATTEST THAT ALL FACTS SET FORTH HEREIN ARE TRUE AND ACCURATE. Signatures Visitor's Signature * signature keyboard Clear Visitor's Name * First Name Visitor's Last Name Last Name Visitor's Email * Visitor's Phone * Visitor's Address * Visitor's Address Street Address Street Address Street Address Line 2 Street Address Line 2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Is the Visitor under the age of 18? * YES - Visitor is under the age of 18 NO - Visitor is 18+ years old Parent/Legal Guardian (complete if Visitor is under the age of 18) Parent/Legal Guardian's Signature * signature keyboard Clear Parent/Legal Guardian's Name * First Name Parent/Legal Guardian's Last Name * Last Name Date Executed EXHIBIT A - Property Being Visited Check any property visitors may be present on. * Sam’s Place, 3259 Youngs Road, 28387 Southern Pines Submit If you are human, leave this field blank.