The group listed below plans a visit to Horse Creek Wildlife Sanctuary and Animal Refuge as detailed below. The group will indemnify and hold harmless The Sharon Charitable Trust, Horse Creek Wildlife Sanctuary and Animal Refuge and its staff and any volunteers involved in this event from responsibility and liability from any injury or illness that a member of this group may sustain during this visit.

In the event of an emergency, personnel representing Horse Creek Wildlife Sanctuary and Animal Refuge are authorized to consent to an X-ray examination, medical, dental, or surgical diagnosis, treatment, and hospital care as advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor's office or in any hospital. Family members will be contacted as soon as possible should any emergency event occur.

Further, it is the responsibility of the sponsor(s) of the visiting group to receive and verify the attached permissions and insurance coverage (as needed and appropriate) for individual attendees.

We further state that our group has insurance coverage described below which covers our liability for the activities on the premises.

Group Name: ____________________________________________________________________

Number of Guests: ______________________ Date of Visit: _____________________________

Facility/Program Reserved: ________________________________________________________

Deposit Submitted: Amount: ______________________ Date: ____________________________

Signature of Sponsor: _____________________________________________________________

Contact Person (if other than Sponsor): _______________________________________________

Emergency Phone Number: _________________________________________________________