HEARTS HAVEN YOUTH RANCH ACTIVITY SPONSOR RELEASE AND HOLD HARMLESS AGREEMENT FOR PARTICIPANTS, STAFF AND VOLUNTEERS

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1 Hearts Haven Youth Ranch 6131 Town Creek Rd Elm City, NC PLEASE FILL OUT ONE FORM PER INDIVIDUAL VISITING HEARTS HAVEN YOUTH RANCH PLEASE PRINT CLEARLY DATE: HEARTS HAVEN YOUTH RANCH ACTIVITY SPONSOR RELEASE AND HOLD HARMLESS AGREEMENT FOR PARTICIPANTS, STAFF AND VOLUNTEERS WARNING Horse, horseback riding and related activities are dangerous and there are risks involved in your participation. You can be seriously/permanently injured or killed as a result of your participation in horses, horseback riding or its related activities. Each individual Participant, regardless of experience, has final READ CAREFULLY AND COMPLETE responsibility ALL for SECTIONS his/her own BEFORE safety. SIGNING READ CAREFULLY AND COMPLETE ALL SECTIONS BEFORE SIGNING This document is meant to be a full and complete release from any and all liability that may arise from my participation in any and all activities sponsored on the property of Hearts Haven Youth Ranch and its owners, employees, and volunteers, jointly and severally. This release is given freely and voluntarily by the participant, spectator and/or guest and is meant to remain in existence throughout the duration of the equine and/or other activities whether I am or am not found to be negligent while handling a horse, near a horse or participating in the activities listed below, or peripheral activities associated with this sport and all other activities on Hearts Haven Youth Ranch. NAME: Age: ADDRESS: Phone # Emergency Contact Info Name: Phone#: Relationship to Participant: Medical Insurance Info: My medical insurance company is My policy number is I do not carry medical insurance Please check all that currently apply to this participant: Age 18 or older Under age 18 Over 200 lbs.? Under 10 hours riding experience? Over 10 hours riding experience? Safety Questions Does the participant have any physical or mental condition(s), which may affect his/her safety and ability to ride, drive and/or train a horse? yes no If you checked Yes how can we help them with their special needs?

2 Warning 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 risk of equine activities. Chapter 99E of the North Carolina general statues IMPORTANT: DOGS MUST BE LEASHED AND UNDER CONTROL AT ALL TIMES NATURAL HAZARDS ON THE FARM ARE AS FOLLOWS: 1) Beware of Fire Ants. These are tiny red ants that sting badly. Do not stand near them or halt your horse near them; 2) Watch out for Snakes. You are on a farm with barns, ponds, and woods all of which are a snake s natural habitat. Not all snakes are poisonous but be careful and keep your eyes open for both ants and snakes. SADDLE GIRTH/NATURAL LOOSENING I/WE ACKNOWLEDGE THAT: Saddle girths (fastener straps around horse s belly) may loosen during riding. Participants must alert the instructor or attendant of any girth looseness so action can be taken to avoid slippage of saddle and the potential for the participant to fall from the horse. PROTECTIVE HEADGEAR/HELMET WARNING I/WE AGREE THAT: I for myself and on behalf of my child and/or legal ward have been fully warned and advised by HEARTS HAVEN YOUTH RANCH that protective headgear/helmet, which while riding meets or exceeds the quality standards of the SEI CERTIFIED ASTM STANDARD F 1163 equestrian Helmet, should be worn while riding and/or driving and/or training and/or being near horses, and I understand that the wearing of such headgear/helmet at these times may reduce severity of some of the wearer s head injuries and possible prevent the wearer s death from happening as the result of a fall and other occurrences. I am not relying HEARTS HAVEN YOUTH RANCH and/or ITS ASSOCIATES to provide a certified helmet for me or to check any headgear/helmet or headgear/helmet strap that I may wear or to monitor my compliance with this suggestion at any time now or in the future. NORTH CAROLINA STATUES 99E-1. Definitions. As used in this Article, the term: (1) "Engage in an equine activity" means participate in an equine activity, assist a participant in an equine activity, or assist an equine activity sponsor or equine professional. The term "engage in an equine activity" does not include being a spectator at an equine activity, except in cases in which the spectator places himself in an unauthorized area and in immediate proximity to the equine activity. (2) "Equine" means a horse, pony, mule, donkey, or hinny. (3) "Equine activity" means any activity involving an equine. (4) "Equine activity sponsor" means an individual, group, club, partnership, or corporation, whether the sponsor is operating for profit or nonprofit, which sponsors, organizes, or provides the facilities for an equine activity. The term includes operators and promoters of equine facilities. (5) "Equine professional" means a person engaged for compensation in any one or more of the following: a. Instructing a participant. b. Renting an equine to a participant for the purpose of riding, driving, or being a passenger upon the equine. c. Renting equipment or tack to a participant. d. Examining or administering medical treatment to an equine. e. Hoof trimming or placing or replacing horseshoes on an equine. (6) "Inherent risks of equine activities" means those dangers or conditions that are an integral part of engaging in an equine activity, including any of the following: a. The possibility of an equine behaving in ways that may result in injury, harm, or death to persons on or around them. b. The unpredictability of an equine's reaction to such things as sounds, sudden movement, unfamiliar objects, persons, or other animals. Inherent risks of equine activities does not include a collision or accident involving a motor vehicle.

3 (7) "Participant" means any person, whether amateur or professional, who engages in an equine activity, whether or not a fee is paid to participate in the equine activity. ( , s. 1.) 99E-2. Liability. (a) Except as provided in subsection (b) of this section, an equine activity sponsor, an equine professional, or any other person engaged in an equine activity, including a corporation or partnership, shall not be liable for an injury to or the death of a participant resulting from the inherent risks of equine activities and, except as provided in subsection (b) of this section, no participant or participant's representative shall maintain an action against or recover from an equine activity sponsor, an equine professional, or any other person engaged in an equine activity for injury, loss, damage, or death of the participant resulting exclusively from any of the inherent risks of equine activities. (b) Nothing in subsection (a) of this section shall prevent or limit the liability of an equine activity sponsor, an equine professional, or any other person engaged in an equine activity if the equine activity sponsor, equine professional, or person engaged in an equine activity does any one or more of the following: (1) Provides the equipment or tack, and knew or should have known that the equipment or tack was faulty, and such faulty equipment or tack proximately caused the injury, damage, or death. (2) Provides the equine and failed to make reasonable and prudent efforts to determine the ability of the participant to engage safely in the equine activity or to safely manage the particular equine. (3) Commits an act or omission that constitutes willful or wanton disregard for the safety of the participant, and that act or omission proximately caused the injury, damage, or death. (4) Commits any other act of negligence or omission that proximately caused the injury, damage, or death. (c) Nothing in subsection (a) of this section shall prevent or limit the liability of an equine activity sponsor, an equine professional, or any other person engaged in an equine activity under liability provisions as set forth in the products liability laws. ( , s. 1.) 99E-3. Warning required. (a) Every equine professional and every equine activity sponsor shall post and maintain signs which contain the warning notice specified in subsection (b) of this section. The signs required by this section shall be placed in a clearly visible location on or near stables, corrals, or arenas where the equine professional or the equine activity sponsor conducts equine activities. The warning notice specified in subsection (b) of this section shall be designed by the Department of Agriculture and Consumer Services and shall consist of a sign in black letters, with each letter to be a minimum of one inch in height. Every written contract entered into by an equine professional or by an equine activity sponsor for the providing of professional services, instruction, or the rental of equipment or tack or an equine to a participant, whether or not the contract involves equine activities on or off the location or site of the equine professional's or the equine activity sponsor's business, shall contain in clearly readable print the warning notice specified in subsection (b) of this section. WARNING Under North Carolina law, there is no liability for an injury to or death of a participant in an agritourism activity conducted at this agritourism location it such injury or death results from the inherent risk of the agritourism activity. Inherent risk of agritourism activities include, among others, risk of injury inherent to land, equipment and animals, as well as the potential for you to act in a negligent manner that may contribute to your injury or death. You are assuming the risk of participating in this agritourism activity NC General Statues (b) The signs and contracts described in subsection (a) of this section shall contain the following warning notice: an agritoursim 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." 99E-30. Definitions. As used in this Article, the following terms mean: (1) Agritourism activity. Any activity carried out on a farm or ranch that allows members of the general public, for recreational, entertainment, or educational purposes, to view or enjoy rural activities, including farming, ranching, historic, cultural, harvest-your-own activities, or natural activities and

4 attractions. An activity is an agritourism activity whether or not the participant paid to participate in the activity. "Agritourism activity" includes an activity involving any animal exhibition at an agricultural fair licensed by the Commissioner of Agriculture pursuant to G.S (2) Agritourism professional. Any person who is engaged in the business of providing one or more agritourism activities, whether or not for compensation. (3) Inherent risks of agritourism activity. Those dangers or conditions that are an integral part of an agritourism activity including certain hazards, including surface and subsurface conditions, natural conditions of land, vegetation, and waters, the behavior of wild or domestic animals, and ordinary dangers of structures or equipment ordinarily used in farming and ranching operations. Inherent risks of agritourism activity also include the potential of a participant to act in a negligent manner that may contribute to injury to the participant or others, including failing to follow instructions given by the agritourism professional or failing to exercise reasonable caution while engaging in the agritourism activity. (4) Participant. Any person, other than the agritourism professional, who engages in an agritourism activity. (5) Person. An individual, fiduciary, firm, association, partnership, limited liability company, corporation, unit of government, or any other group acting as a unit. ( , s. 1; , s. 1.) 99E-31. Liability. (a) Except as provided in subsection (b) of this section, an agritourism professional is not liable for injury to or death of a participant resulting from the inherent risks of agritourism activities, so long as the warning contained in G.S. 99E-32 is posted as required and, except as provided in subsection (b) of this section, no participant or participant's representative can maintain an action against or recover from an agritourism professional for injury, loss, damage, or death of the participant resulting exclusively from any of the inherent risks of agritourism activities. In any action for damages against an agritourism professional for agritourism activity, the agritourism professional must plead the affirmative defense of assumption of the risk of agritourism activity by the participant. (b) Nothing in subsection (a) of this section prevents or limits the liability of an agritourism professional if the agritourism professional does any one or more of the following: (1) Commits an act or omission that constitutes negligence or willful or wanton disregard for the safety of the participant, and that act or omission proximately causes injury, damage, or death to the participant. (2) Has actual knowledge or reasonably should have known of a dangerous condition on the land, facilities, or equipment used in the activity or the dangerous propensity of a particular animal used in such activity and does not make the danger known to the participant, and the danger proximately causes injury, damage, or death to the participant. (c) Nothing in subsection (a) of this section prevents or limits the liability of an agritourism professional under liability provisions as set forth in Chapter 99B of the General Statutes. (d) Any limitation on legal liability afforded by this section to an agritourism professional is in addition to any other limitations of legal liability otherwise provided by law. ( , s. 1.) 99E-32. Warning required. (a) Every agritourism professional must post and maintain signs that contain the warning notice specified in subsection (b) of this section. The sign must be placed in a clearly visible location at the entrance to the agritourism location and at the site of the agritourism activity. The warning notice must consist of a sign in black letters, with each letter to be a minimum of one inch in height. Every written contract entered into by an agritourism professional for the providing of professional services, instruction, or the rental of equipment to a participant, whether or not the contract involves agritourism activities on or off the location or at the site of the agritourism activity, must contain in clearly readable print the warning notice specified in subsection (b) of this section. (b) The signs and contracts described in subsection (a) of this section must contain the following notice of warning: Under North Carolina law, there is no liability for an injury to or death of a participant in an agritourism activity conducted at this agritourism location if such injury or death results from the inherent risks of the agritourism activity. Inherent risks of agritourism activities include, among others, risks of injury inherent to land, equipment, and animals, as well as the potential for you to act in a negligent manner that may contribute to your injury or death. You are assuming the risk of participating in this agritourism activity." (c) Failure to comply with the requirements concerning warning signs and notices provided in this subsection will prevent an agritourism professional from invoking the privileges of immunity provided by this Article. ( , s. 1.)

5 AGREEMENT SCOPE AND TERRITORY AND DEFINITIONS: This agreement shall be legally binding upon me the registered PARTICIPANT, and the parents or legal guardians thereof if a minor, my heirs, estate, assigns, including all minor children, and personal representatives; and it shall be interpreted according to the laws of North Carolina. This Agreement is intended to be valid and binding at all times now and in the future when HEARTS HAVEN YOUTH RANCH permits me (directly or indirectly) to enter its property, be on HEARTS HAVEN YOUTH RANCH property, be near any horse, receiving riding and/or training instruction or guidance from its associates and/or when I ride and/or train and/or am near horses on or off of HEARTS HAVEN YOUTH RANCH S property. Any dispute by the PARTICIPANT shall be litigated in, and venue shall be the county in which HEARTS HAVEN YOUTH RANCH is physically located. This Agreement is intended to be as broad and inclusive as the law permits. If any clause, phrase or word is in conflict with North Carolina law, then that single part is null and void. The term HORSE and EQUINE herein shall refer to all equine species. The term I, WE, ME, MY, shall herein refer to the above registered participant and the parents or legal guardians thereof if a minor. INHERENT RISKS/ASSUMPTION OF RISK I/WE ACKNOWLEDGE THAT: Risks, conditions, and dangers are inherent in, meaning and integral part of horse/equine/animal activities/farm activities, regardless of all feasible safety measures which can be take, and I agree to assume them. The inherent risks include, but are not limited to any of the following: The propensity of any animal to behave in ways that may result in injury, harm, death or loss to persons on or around the animals; the unpredictability of an equine s reaction to sounds, sudden movement, unfamiliar objects persons, or other animals; hazards, including, but not limited to, surface or subsurface conditions; a collision, encounter and/or confrontation with another equine, another animal, a person, or an object; the potential of an equine activity participant to act in a negligent manner that may contribute to injury, harm, death, or loss to the participant or to the other persons, including but not limited to, failing to maintain control over an equine and/or failing to act within the ability of the participant. Horses are 5-15 times larger, times more powerful, and 3-4 times faster than a human. If a participant falls from horse to ground it will generally be a distance of from 3.5 to 5.5 feet and the impact may result in harm to the participant. Horseback riding and equine training are activities in which one much smaller, weaker predator (the human) tries to impose its will on, and become one unit of movement with, another much larger, stronger prey animal that has a mind of its own (the horse) and each has a limited understanding of the other. If a horse is frightened or provoked it may diver from its training and act according to its natural survival instincts which may include, but are not limited to: stopping short; spinning around; changing directions and/or speed at will; shifting its weight; bucking; rearing; kicking; biting and/or running from danger. I also acknowledge that these are just some of the risks and I agree to assume there are others not mentioned above. I am not relying on Hearts Haven Farms to list all possible risks for me. CONDITIONS OF NATURE WARNING, UNFAMILIAR AND SUDDEN SIGHTS, SOUNDS AND MOVEMENTS AND WARNING, AND INSPECTION OF PREMISES I/WE AGREE THAT: HEARTS HAVEN FARM is NOT responsible for total or partial acts, occurrences, or element of nature and/or sudden and/or unfamiliar sights, sounds and/or sudden movements that can scare a horse, cause it to fall, or react in some other unsafe way. SOME EXAMPLES ARE: thunder, lightning, rain, wind, wild and domestic animals, insects, reptiles, which may walk, run, or fly near, or bite or sting a horse or person; and irregular footing on outdoor groomed or wild land which is subject to constant change in condition according to weather, temperature, and natural and man-made changes in landscape. I also understand that these are just some of the risks and I agree to assume others which are not mentioned above. I am not relying on HEARTS HAVEN YOUTH RANCH to list all possible conditions for me. The participant and parent or legal guardian have inspected HEARTS HAVEN YOUTH RANCH facilities and are satisfied that all premise conditions are reasonable safe for this participant s intended purpose, usage and presence upon HEARTS HAVEN YOUTH RANCH premises. EQUINE ACTIVITY LIABILITY ACT (EALA) WARNING OR LANGUAGE: I/WE ACKNOWLEDGE THAT: I have reviewed North Carolina s EQUINE ACTIVITY LIABILITY ACT WARNING OR LANGUAGE, a copy of which is printed herein. AGRITOURSIM ACTIVITY LIABILITY ACT WARNING OR LANGUAGE: I/WE ACKNOWLEDGE THAT: I have reviewed North Carolina s AGRITOURSIM ACTIVITY LIABILITY ACT WARNING OR LANGUAGE, a copy of which is printed herein. MEDICAL INSSURANCE I/WE AGREE THAT: should medical treatment, I and/or my medical insurance company shall pay for ALL such incurred expenses.

6 PHOTO RELEASE I/WE RELEASE: All right to photos taken of me/us or the above mentioned for future use by HEARTS HAVEN FARMS, its staff, founders, and/or Board of Directors in publications, videos, books, newsletters, etc. SAFETY AGREEMENT I/WE AGREE: to stay out of all barns, paddocks, corrals, tack-rooms, and all other non-office related buildings, while waiting for horse related or other activities, or while waiting for a participant. LIABILITY RELEASE I/WE AGREE THAT: In consideration of Hearts Haven Farm allowing my participation in this activity, under the terms set forth herein, I, the participant, for myself and on behalf of my child and/;or legal ward, heirs, administrators, personal representatives or assigns, do agree to release, hold harmless, and discharge Hearts Haven Farm, its owners, agents, employees, officers, directors, representatives, assigns, members, owners of premises and trails, affiliated organizations, and insurers, and others acting on their behalf (hereinafter, collectively referred to as ASSOCIATES ), of and from all claims, demands, causes of action and legal liability, whether the same be known or unknown, anticipated or unanticipated, due to HEARTS HAVEN YOUTH RANCH and/or ITS ASSOCIATE S ordinary negligence or legal liability; and I do further agree that except in the event of Hearts Haven Farm s gross negligence and/or willful and or wanton misconduct, I shall not bring any claims, demands, legal action and causes of action, against HEARTS HAVEN YOUTH RANCH and/or IT S ASSOCIATIES as stated above in this clause, for any economic and non-economic losses due to bodily injury and/or death and or property damage, sustained by me and/or my minor child or legal ward in relation to the premises and operations of HEARTS HAVEN, to include while riding, driving, training, handling, or otherwise being near horses owned by me or owned by HEARTS HAVEN FARM, or in the care, custody or control of HEARTS HAVEN YOUTH RANCH whether on or off the premises of HEARTS HAVEN YOUTH RANCH, but not limited to being on HEARTS HAVEN YOUTH RANCH premises as a participant, spectator and/or guest. *All Participants and/or Legal Guardians must sign below after reading this entire document.* SIGNER STATEMENT OF AWARENESS I/WE THE UNDERSIGNED, REPRESENT THAT I/WE HAVE READ AND DO UNDERTAND THE FOREGOING AGREEMENTS, LIAABILITY RELEASE AND ASSUMPTION OR RISK AGREEMENTS. I/WE UNDERSTAND THAT BY SIGNING THIS DOCUMENT I AM GIVING UP RIGHTS TO SUE TODAY AND IN THE FUTURE. I/WE ATTEST THAT ALL FACTS ARE TRUE AND ACCURATE. I AM SIGNING THIS WHILE OF SOUND MIND AND NOT SUFFERING FROM SHOCK, OR UNDER THE INFLUENCE OF ALCOHOL, DRUGS OR INTOXICANTS. Bible Study Notification: Please be advised that Bible study and references to the Lord Jesus Christ are an integral part of our daily routine here at Hearts Haven Youth Ranch. Signature of Participant (required for anyone 13 and over) Signature of Legal Guardian (required for anyone under 18) Date: Date: ***Legal guardians do not include babysitters or friends of the family, unless that individual has been named guardian by a legal process, signed notes are not considered Legal.