AGREEMENT FOR RELEASE AND WAIVER OF LIABILITY

FOR MYSELF OR MY MINOR CHILD

I request permission for myself or my minor child, named below, to participate in cross-country riding and fox hunting with the Piscataqua Hounds.  I fully understand that cross-country horseback riding and fox hunting (which includes riding over fences, other obstacles, and over steep and rough terrain) are very dangerous activities.  I wish to allow my child, or to be allowed myself, to participate in these activities knowing they are dangerous.  I accept and assume all the risks of injury (including death) for myself, my child, or to my property.  I represent and warrant that I have the authority to give this release.  In exchange for myself or my child being permitted to participate in these activities, for myself, for my child, my heirs, my child's heirs, guardians, and legal representatives, I release and agree not to make or bring any claim of any kind against the Piscataqua Hounds, or its master, members, employees or guests or any landowners, landholders or other persons making property available for the Piscataqua Hounds, for any injury (including death) to myself, or to my child, or any damage to my property, whether from anyone's negligence or not, or any other cause arising out of my participation or my child's participation in these dangerous horseback riding, fox hunting or related activities.  I also agree if anyone makes any claims because of any injury to myself or my child (including death), or for any damage to my property, I will keep all those released by this agreement free of any damages or costs because of those claims.

Signature:_____________________________                      Date:__________________________

                   (Self and/or Parent/Guardian for Minor Child)

Printed Name:_________________________                       Horse:_________________________

Address:_______________________________________________________________________

Phone:___________________(Home)__________________(Work)____________________(Cell)