COWBOY CHURCH OF LEON COUNTY
P O Box 1078 1419 Hwy 7 East, Centerville, TX, 75833 (903) 536 8020
LIABILITY RELEASE FORM
I, _______________________________________, hereby release and hold harmless the Cowboy Church of Leon County from any and all liability for any injury to myself/my child, damages to my person, property, and/or horse, or death of myself/my child resulting from or being incurred during my/my child’s participation in any equine, rodeo or other activities sponsored by or held at the property of the Cowboy Church of Leon County. I am aware that equine and rodeo activities are inherently dangerous and I am assuming all liability and responsibility for my/my child’s actions. I further acknowledge that should any injury, damages or death occur, I will accept full responsibility, financial and otherwise for such losses.
I,____________________________, parent/guardian of ______________________________, a minor child, hereby grant my permission for said aforementioned minor child to participate in rodeo or equine activities sponsored by or held at the property of the Cowboy Church of Leon County. As stated above, I hereby release and hold harmless the Cowboy Church of Leon County from any and all liabilities for any loss, injury, damages, or death to my child, myself, our horses and our personal property, if such losses should occur during my child’s participation in an equine, rodeo or other activity sponsored by or held at the Cowboy Church of Leon County.
I do/do not (circle one) give permission for pictures to be used in promoting the CCLC Arena events.
I further agree that this release is effective from January 1, through December 31, and shall remain in effect unless withdrawn in writing by me.
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Printed name of Adult participant or parent/guardian of minor Phone Number
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Address (number, street) City, State Zip Code
Name of Minor Participant:____________________________ Age of Child______________
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SIGNATURE of Adult Participant or Parent/Guardian Date
The foregoing instrument was acknowledged before me this _______day of ________, by _________________________________.
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CCLC Witness CCLC Witness Name (printed)
