HERB N CHICK        

8613 Oglesby Ave. Jacksonville, Florida
Phone: 904-413-1514  * Email: Admin@HerbNChick.com
HERB N Chick INC.
ACKNOWLEDGMENT OF RISKS, ASSUMPTION OF RISK AND RESPONSIBILITY, 
& RELEASE OF LIABILITY
WARNING: SERIOUS INJURY MAY RESULT FROM
YOUR PARTICIPATION IN THIS ACTIVITY, OR ON THESE PREMISES.
HERB N CHICK CANNOT AND DOES NOT GUARANTEE YOUR SAFETY.
PLEASE READ CAREFULLY. THIS IS A LEGAL DOCUMENT.
I (NAME) ____________________________UNDERSTAND THAT: any activity associated with Archery, Fishing, Games, Outdoor Activities, Domesticated Animals and Wildlife have numerous obvious and non-obvious inherent risks always present to such activity despite all safety precautions. I UNDERSTAND THAT although domesticated and farm animals usually have a calm disposition, no animal is completely safe or predictable.
I assume the risk of personal injury, accidents and/or illness, including but not limited to sprains, torn muscles and/or ligaments; fractured or broken bones; eye damage; cuts; wounds; scrapes; abrasions, and/or contusions; dehydration, head, neck and/or spinal injuries; animal or insect bite or attack; shock, paralysis, drowning and/or death.
AUTHORIZATION: I hereby authorize any medical treatment deemed necessary in the event of any injury that may occur while I am at Herb N Chick Inc. Either I have appropriate insurance, or in its absence, agree to pay all costs of medical services as may be incurred on my behalf. Should anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
RELEASE OF LIABILITY: I agree that in consideration of Herb N Chick Inc. allowing my participation (or my child’s, as the case may be) in this activity, under the terms set forth, I, the participant, (and/or legal guardian thereof) for myself and on behalf of my child and/or legal ward DO AGREE TO HOLD HARMLESS, RELEASE, AND DISCHARGE HERB N CHICK INC. AND/OR ASSOCIATES ORDINARY NEGLIGENCE; AND DO FURTHER AGREE THAT WE SHALL NOT BRING ANY CLAIMS, DEMANDS, LEGAL ACTIONS AND CAUSES OF ACTION, AGAINST HERB N CHICK INC. AND ITS ASSOCIATES AS STATED ABOVE IN THIS CLAUSE, AND FOR ANY ECONOMIC AND/OR NON-ECONOMIC LOSSES DUE TO BODILY INJURY, DEATH, PROPERTY DAMAGE SUSTAINED BY ME AND/OR MY MINOR CHILD OR LEGAL WARD IN RELATION TO THE PREMISES AND OPERATIONS OF HERB N CHICK.  TO INCLUDE RIDING, HANDLING, HAULING OR OTHERWISE BEING IN THE PRESENCE OF ANIMALS OWNED BY OR IN THE CARE, CUSTODY AND CONTROL OF HERB N CHICK INC. WHETHER ON OR OFF THE PREMISES OF HERB N CHICK INC. I DO HEREBY RELEASE FROM ANY LEGAL LIABILITY, AGREE NOT TO SUE, CLAIM AGAINST, ATTACH THE PROPERTY OF, OR PROSECUTE AND FURTHER AGREE TO DEFEND, INDEMNIFY AND HOLD HERB N CHICK INC.,ALL OF THEIR ASSOCIATES, OFFICERS, MEMBERS, ORGANIZATIONS, AGENTS, INDEPENDENT CONTRACTORS AND EMPLOYEES FOR ANY INJURY OR DEATH CAUSED BY OR RESULTING FROM MY PARTICIPATION IN THE ACTIVITIES DESCRIBED ABOVE OR BEING ON PREMISES. SUCH AS COLLISION WITH FIXED OBJECTS OR PEOPLE: SLIPPING AND FALLING: MUSCULUSKELETAL INJURIES INCLUDING HEAD, NECK AND BACK INJURIES; EXHAUSTION;EXPOSURE TO TEMPERATURE AND WEATHER EXTREMES; EXPOSURE TO POTENTIALLY DANGEROUS WILD ANIMALS, INSECT BITES, AND HAZARDOUS PLANT LIFE; THE NEGLIGENCE OF OTHER PARTICIPANTS, OR OTHER PERSONS WHO MAY BE PRESENT; WHETHER OR NOT SUCH INJURY OR DEATH WAS CAUSED BY THEIR NEGLIGENCE OR FROM ANY OTHER CAUSE. 
In the event that I file a lawsuit against HERB N CHICK INC., I agree to do so solely in the state of Florida, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.
PHOTO RELEASE:  Photographs and videos are routinely taken at Herb N Chick. I release the use of my image for the purposes of photographing or video-recording the events, but not for commercial purposes. With my signature below, I agree that images of me that are taken at this event by or on behalf of the event organizer may be used without compensation or additional permission.  
I HAVE READ AND UNDERSTAND THE FOREGOING ACKNOWLEDGEMENT OF RISK, ASSUMPTION OF RISK AND RESPONSIBILITY, AND RELEASE OF LIABILITY.
Must be signed by parent if under 18 yrs.
Participant or Parent or Guardian’s name (printed): ___________________Date: _________ 
Participant or Signature of Parent or Guardian: ______________________Date:_________
EMERGENCY NUMBER _____________________E-MAIL ADDRESS __________________________