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What is your birthdate? *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
First Name *
Last Name *
Mobile Phone *
Parent Name (if under 18)
Parent Mobile (if different )
SMS/text messaging: By providing your mobile number and checking the box below, de la Cruz Farms Inc. will be allowed to send you SMS (text) messages relating to their volunteer activities. To opt-out, reply STOP to any SMS message OR return to this form and uncheck the box.
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What is your t shirt size? *
Please provide a brief paragraph telling us your testimony. *
What church do you attend? *
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Do you consent to a background check? (For those 18 and older)

Please provide your Social Security Number for a Background Check (For those 18 and older)
de la CRUZ Farms has animals and honeybees on site. Do you have any allergies we should be aware of?

Waiver

A. AGREEMENT SCOPE AND TERRITORY AND DEFINITIONS: This agreement shall be legally binding upon me the registered volunteer, my heirs, estate, assigns, including all minor children, and personal representatives; and it shall be interpreted according to the laws of the state and county of This Farm’s physical location. This agreement is intended to be valid and binding at all times now and in the future when This Farm permits me (directly or indirectly) to enter This Farm’s property, be on this This Farm’s property, be near any horse, receive horse activity instruction or guidance from its associates and/or when I am near horses on or off of This Farm’s property. Any disputes by the volunteer shall be litigated in, and venue shall be the county in which This Farm’s 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 state law, then that single part is null and void. The terms “Horse” and “Equine” herein shall refer to all equine species. The terms, “I”, “We”, “Me”, “My” shall herein refer to the above registered volunteer and the parents or legal guardians thereof if a minor.
B. INHERENT RISKS/ASSUMPTION OF RISKS: I/We acknowledge that: Risks, conditions, and dangers are inherent in horse/equine/animal/bee activities, regardless of all feasible safety measures which can be taken, and I agree to assume them. The inherent risks include, but are not limited to any of the following: The possibility of an animal to behave in ways that may result in injury, harm, death, or loss to persons on or around the animal; 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 volunteer to act in a negligent manner that may contribute in injury, harm, death, or loss to the volunteer or to other persons, including but not limited to, failing to maintain control over an equine and/or failing to act within the ability of the volunteer. Horses are 5 to 15 times larger, 20 to 40 times, more powerful, and 3 to 4 times faster than a human. If a rider falls from a horse to the ground it will generally be at a distance of from 3 ½ to 5 ½ feet, and the impact may result in harm to the rider. Horse activities in which one much smaller, weaker predator animal (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 divert 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 others not mentioned above. I am not relying on This Farm to list all possible risks for me.
C. CONDITIONS OF NATURE WARNING. UNFAMILIAR AND SUDDEN SIGHTS, SOUNDS AND MOVEMENTS WARNING AND INSPECTION OF PREMISES: I/We acknowledge that: This Farm is NOT responsible for total or partial acts, occurrences, or elements 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 out-of-door 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 not mentioned above. I am not relying on This Farm to list all possible conditions for me. The volunteer or parent or legal guardian have inspected This Farm’s facilities and are satisfied that all premise conditions are reasonably safe for this volunteer’s intended purpose
to monitor my compliance with this suggestion at any time now or in the future.
D. LIABILITY RELEASE: I/We agree that: If a minor, at least one parent or legal guardian agrees to remain on The Farm facility while volunteer is participating in activities and monitor the activities from a distance and to immediately notify The Farm staff of any behavior or activities that may be potentially unsafe for Volunteer. In consideration of This Farm allowing my participation in this activity, under the terms set forth herein, I, the volunteer, 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 This Farm, its owners, agents, employees, officers, directors, representatives, volunteers, assigns, members, owners of premises and trails, affiliated organizations, and insurers, and others activating 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 This Farm’s and/or its Associates ordinary negligence or legal liability; and I do further agree that except in the event of This Farm’s gross negligence and/or willful and/or wanton misconduct, I shall not bring any claims, demands, legal actions and causes of action, against This Farm and its Associates 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 This Farm, to include while participating in any horse activities or otherwise being hear horses owned by This Farm, or in the care or custody or control of This Farm whether on or off the premises of This Farm, but not limited to being on This Farm’s premises.
E. NORTH CAROLINA 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 risks of equine activities. Chapter 99E of the North Carolina General Statutes.
F. PHOTO, VIDEO, QUOTE, SOCIAL MEDIA AND INTERVIEW CONSENT AND RELEASE: I hereby consent to and authorize the use by de la Cruz Farms and its affiliates, subsidiaries, representatives and assigns of the following (collectively, the “Media”)in promotional advertising materials (TV, Radio, Print), social media (Facebook, YouTube, Twitter, etc.), on de la Cruz Farms websites, in media articles, and any other from in any media whatsoever, whether now known or hereafter created, for illustration, promotion, art, editorial, advertising and trade, or any other purpose whatsoever without restriction as to alteration: permission to take and use photographs, videos, voice recordings and or other media of me, my children, our heirs, assigns and personal representatives;, including derivative works, thereof; permission to use my comments as a quote and or use information I provide during an interview; and permission to use my first name in connection therewith. I acknowledge that I am eighteen years old or more and that I am the parent/guardian of the participant named on this application.. I hereby waive, release, discharge and hold harmless de la Cruz Farms and its officers, directors, employees, agents, predecessors, successors, assigns, representatives and affiliates from any and all claims and demands arising out of or in connection with use of the Media, including without limitation any and all claims for libel, defamation, publicity, appropriation of likeness or invasion of privacy.
G. SIGNER STATEMENT OF AWARENESS: I/We, the undersigned, represent that I/We have read and do understand this agreement. I/We attest that all facts are true and accurate. The information I have provided on this form is correct to the best of my knowledge. I understand false information or significant omission may disqualify me from further consideration for service, or may be just cause for my dismissal if discovered at a later date. I understand that not abiding by the mission, policies, rules, or expectations of de la Cruz Farms may be grounds for a skills development plan or my dismissal as determined by the Board of Directors. I give de la Cruz Farms the right to investigate the references and to secure additional information about me, if service related. I hereby release from liability de la Cruz Farms and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. I waive any right to inspect references provided on my behalf.

OUR MISSION AND CORE VALUES
Our mission here at the farm is to provide a safe, interactive experience for children and families to grow in the knowledge of God Himself and His Son, Jesus Christ. Our core values include commitment to Jesus Christ, compassion for others, community involvement and humility.
Will you agree to abide by and honor the statement of faith, by laws, policies, rules, expectations, and activities of de la Cruz Farms to the best of your understanding and abilities?