Name(Required)
First
Last
Address(Required)
Are you bringing a horse to camp?(Required) Are you staying overnight at camp?(Required) Camp Set-up & Clean-up(Required) Mentors are required to either assist with set up on the Saturday prior to camp or stay after check out to aid in clean up. If a mentor is able to do both, it is welcomed and encouraged. What day are you able to assist?
Primary Parent/Guardian(Required)
First
Last
Secondary Parent/Guardian Name
First
Last
Experience What electives would you be interested in being part of?(Required) Tell us what types of electives/classes you feel you could either lead/instruct/co-instruct/assist with. If there is an elective/class you'd like to host or have an idea for, please share.
Why do you want to be a mentor? What skills do you feel you’d bring to the Mentor Team and camp as a whole?(Required)
MENTOR HORSES Consent(Required) Mentor Horse Guidelines
Equine Emergency Contact Name(Required)
First
Last
IOWA CODE CHAPTER 673 Consent(Required) Iowa Code Chapter 673
MENTOR CODE OF RESPONSIBILITIES Consent(Required) Mentor Code of Responsibilities
RELEASE AND WAIVER OF RIGHT TO SUE AND ASSUMPTION OF ALL RISK Warning: Under Iowa Law, a Domesticated Animal Professional is not liable for damages suffered by, an injury to, or the death of a participant resulting from the inherent risks of domesticated animal activities, pursuant to Iowa Code chapter 673. You are assuming inherent risks of participating in this domesticated animal activity.
A number of inherent risks are associated with a domesticated animal activity. A domesticated animal may behave in a manner that results in damages to property or an injury or death to a person. Risks associated with the activity may include injuries caused by bucking, biting, stumbling, rearing, trampling, scratching, pecking, falling, stepping on, pulling, or butting.
The domesticated animal may react unpredictably to conditions, including, but not limited to, a sudden movement, loud noise, an unfamiliar environment, or the introduction of unfamiliar persons, animals or objects.
The domesticated animal, may also react in a dangerous manner when a condition or treatment is considered hazardous to the welfare of the animal: a collision occurs with an object or animal: or a participant fails to exercise reasonable care, take adequate precautions, or use adequate control when engaging in a domesticated animal activity, including failing to maintain reasonable control of the animal or failing to act in a manner consistent with the person’s abilities.
The Equine Activity Liability Release, Waiver of Right to Sue and Assumption of all Risk Agreement (this Agreement) is hereby given by the person signed below (the Undersigned) to the Eastern Iowa Horse and Pony Camp, its organizational committee, the Great Jones County Fairgrounds, the camp staff, Fair Employees, and assigns for the use, the week of camp and on all future dates of the property, facilities or services.
The Undersigned acknowledges that he/she has been advised and does otherwise understand and acknowledge that anything to do with horses, including to but not limited to, riding, competing with, handling, exercising, training or working around them is an inherently dangerous activity AND HEREBY ASSUMES ALL RISKS INHERENT IN EQUINE ACTIVITY.
Being aware of this, and in consideration of the right to participate in any event sponsored by the Eastern Iowa Horse & Pony Camp, the Undersigned hereby acknowledge that the same are safe and suited for the purpose intended.
The Undersigned agrees to accept full responsibility for, and the risk of bodily injury, death, or property damage that he/she may suffer as a result of riding, working at, or participating in any activity sponsored by the Eastern Iowa Horse and Pony Camp.
The Undersigned further hereby RELEASES, agrees to assume all risks, and waives all rights which he/she, his/her children or spouse, if any, heirs, administrators, personal representatives, or assigns may have or hereafter have against the Eastern Iowa Horse & Pony Camp, its organizational committee, volunteers or staff, The Great Jones County Fairgrounds and its Board of Directors, and employees, for death, personal injury, or damage which is in any way associated with any activity sponsored by the Eastern Iowa Horse & Pony Camp, and hereby Waives the right to sue or bring any action against them.
This agreement is non-assignable and non-transferable and is made and entered into the State of Iowa and shall be enforced and interpreted under the laws of this state.
The Undersigned agrees that he/she and his/her parents or guardians have read this agreement, understand it, and are signing it, voluntarily.
Consent(Required) Release and Waiver of Right to Sue and Assumption of All Risk
ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19 The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. The Eastern Iowa Horse & Pony Camp has put in place preventative measures to reduce the spread of COVID-19; however, the Eastern Iowa Horse & Pony Camp cannot guarantee that you will not become infected with COVID-19. Further, participation could increase your risk of contracting COVID-19.
READ CAREFULLY BEFORE SIGNING
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my camper may be exposed to or infected by COVID-19 by participation; and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Eastern Iowa Horse & Pony Camp of the current year of this registration may result from the actions, omissions, or negligence of my mentor/camper and others, including, but not limited to, Eastern Iowa Horse & Pony Camp’s employees, volunteers, directors, and program participants and their families.
By signing this agreement, I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my mentor/camper (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that they may experience or incur in connection with their participation at The Eastern Iowa Horse & Pony Camp of the current registration year. 3. On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless the Eastern Iowa Horse & Pony Camp, its employees, agents, volunteers, directors, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Eastern Iowa Horse & Pony Camp, its employees, agents, volunteers, directors, and representatives, whether a COVID-19 infection occurs before, during, or after participation at The Eastern Iowa Horse & Pony Camp of the current registration year.
By signing this agreement, I represent that I have adequate insurance to cover any injury or illness my mentor/camper may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or illness myself. I further represent that my camper has no medical or physical condition which could interfere with their safety in this activity, or else I am willing to assume – and bear the costs of – all risks that may be created, directly or indirectly, by any such condition.
By signing this document, I agree that if my camper is exposed or infected by COVID-19 during their participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence.
By signing this document, I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to my mentor/camper or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain. I have read and understood this document and I agree to be bound by its terms.
By signing this document, if I have signed a separate general waiver of liability connected to my mentor/camper’s participation at the Eastern Iowa Horse & Pony Camp of the current year that is being registered, I agree that the terms of that waiver are wholly incorporated into this document and that the terms of this document are incorporated into the separate general waiver.
By signing this document, in consideration of myself and/or minor being permitted to participate in this activity, I further agree to indemnify and hold harmless releases from any claims alleging negligence which are brought by or on behalf of minor or are in any way connected with such participation by minor. By signing this document, I acknowledge that I have read and understand the Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 waiver.
Consent(Required) Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
MEDIA RELEASE Consent(Required) Media Release
PRIVATE/PUBLIC TRANSPORTATION CONSENT & RELEASE Consent(Required) Private/Public Transportation Consent & Release
ELECTRONIC SIGNATURE OF ALL CONSENTS, WAIVERS, AND FORMS Consent(Required) Mentor Electronic Signature Authorization
By signing electronically, you agree that your electronic signature is the legal equivalent of your manual/handwritten signature. By providing your electronic signature, you confirm that you have read, understand, and agree to the terms and conditions outlined in this waiver.
MENTOR(Required) The undersigned agree that they have read all the content, documents, agreements, and waivers prior to this and understand it, and are signing voluntarily. Please type your first and last name below as well as provide your signature.
First
Last
Consent(Required) Parent/Guardian/Adult Mentor Electronic Signature Authorization
By signing electronically, you agree that your electronic signature is the legal equivalent of your manual/handwritten signature. By providing your electronic signature, you confirm that you have read, understand, and agree to the terms and conditions outlined in this waiver.
PARENT/GUARDIAN/ADULT MENTOR(Required) The undersigned agree that they have read all the content, documents, agreements, and waivers prior to this and understand it, and are signing voluntarily. Please type your first and last name below as well as provide your signature.
First
Last
SUBMISSION Final Notes Are there any additional notes, comments, or things that the EIHPC Board and Mentor Committee should know?
SIGN ME UP!(Required) I WANT TO BE A MENTOR AT EIHPC!
