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Microsoft word - lasix waiver _2_
MANITOBA THOROUGHBRED E.I.P.H. PROGRAM WAIVER
The undersigned ______________________________________being the authorized agent of
the owners of the thoroughbred horses in my care for the race season____________________
hereby request that the eligible horses be admitted to the Manitoba Thoroughbred E.I.P.H.
Program in accordance with the rules of the Manitoba Horse Racing Commission and the
program set forth in Race Track Supervision Regulations under the Criminal Code relating to the
use of furosemide (lasix)
IN CONSIDERATION of these horses being admitted to the E.I.P.H. Program , the undersigned
agrees to execute any further documentation relating to the E.I.P.H. Program-lasix use and
further agrees to the horses being injected with furosemide, the racing of these horses on same,
the subsequent testing therefore after any races these horses may have competed in.
The undersigned, acting on behalf of the owners, their respective heirs, executors, administrators,
successors and assigns hereby releases and forever discharges Can Test Ltd., its employees,
contracted veterinarian and animal health technicians, agents and all other persons associated
therewith in any capacity whatever, and Elders Equine Clinic, its members, employees,
veterinarians, animal health technicians agents and all other persons, their respective heirs,
executors, administrators, successors and assigns associated therewith in any capacity whatever,
and the Horsemen’s Benevolent Protective Association Manitoba Inc., its members, employees,
and all other persons, their respective heirs, executors, administrators, successors, assigns
associated therewith in any capacity whatever, from any and all action, causes of action, claims
and demands for, upon and by reason of any damage, loss, injury, death, late injection, or failure
to inject the aforesaid horses , or any other matter whatsoever relating to the program and the
administration of, racing on and testing for furosemide (lasix) or any other matter relating
This document being signed by an authorized agent on behalf of the owners, the agent represents
by signing hereunder that he/she has obtained the necessary written authority of the owners and
is legally entitled to sign this waiver and release on the owners behalf.
DATED at Winnipeg, Manitoba this ______________day of __________200___
ACKNOWLEDGEMENT This waiver is a legal document which will be relied upon in defense of any court damages which may result to the horses under the care of the undersigned as a result of being admitted to the lasix program and the subsequent administration thereof. I acknowledge that I have the legal right to obtain legal advice as to the legal meaning and effect of this document but choose not to avail myself of this right ____________________________________
Yasmin Emery-Brownlie 3966 Green Valley Rd, Rescue, California 95672 · firstname.lastname@example.org · Tel: 831-917-5896 Personal Statement I am a California native whose involvement with horses spans nearly 40 years. I attended college and graduate schools on the East Coast while also spending nine years training with Olympic veteran and coach George H. Morris. I have worked at numero
PATIENT INFORMATION FORM – GASTROSCOPIES (EGD) DATE OF PROCEDURE : ________________________________________________ Please arrive 30 minutes before your scheduled time Preparation for a procedure is very important. Proper preparation will reduce the risks of the procedure and will assist in obtaining proper results. PLEASE NOTE: YOU MAY REQUIRE SEDATION DURING YOUR PROCED