Membership & Registration

Join the Haystack Riders Club today!

Please complete the form in full and submit it. To activate your membership, payment via VENMO is required after submission. Ensure all registered users are available to sign the form before submitting it.

Hermitage Club Member Number(Required)

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Email(Required)

Haystack Riders Club Member Agreement(Required)

In exchange for the privilege of membership in the HAYSTACK RIDERS CLUB and of operating an ATV or UTV on HERMITAGE MEMBERS’ CLUB property, I agree as follows:

1. I will join and remain a member in good standing of the HAYSTACK RIDERS CLUB for so long as I wish to be allowed to operate an ATV or UTV on Hermitage Club property.

2. I, and all others identified as authorized to operate an ATV/UTV registered in the HAYSTACK RIDERS CLUB under my membership, will follow and be bound by all HAYSTACK RIDERS CLUB rules, all HERMITAGE MEMBERS’ CLUB rules, and the Town of Wilmington ordinance regulating the use of ATVs or UTVs on public roadways, all of which are linked or attached hereto and incorporated by reference into this Agreement.

3. I will provide evidence of current registration and insurance coverage for any ATV or UTV for which I wish to obtain a HAYSTACK RIDERS CLUB decal along with my initial membership application and with each subsequent annual renewal. In accordance with the Town of Wilmington ordinance and HAYSTACK RIDERS CLUB rules, I will at all times maintain insurance coverage on my ATV/UTV in the following amounts:

- Bodily injury (per person) $250,000
- Bodily injury (per incident) $500,000
- Property damage (per incident) $100,000

4. I will timely pay the HAYSTACK RIDERS CLUB setup fee and annual dues.

5. I ACKNOWLEDGE, AGREE AND UNDERSTAND that the use of ATVs and UTVs may pose risks including injury to myself or others, disability, paralysis, or death, and other damages including damage to property belonging to me or to others. I expressly and voluntarily assume these risks, and agree to be held solely responsible for my own actions.

6. On behalf of myself and my children, any other minor for whom I am the guardian, and my heirs and successors in interest, I now and forever WAIVE, RELEASE, and DISCHARGE the HAYSTACK RIDERS CLUB, the HERMITAGE MEMBERS’ CLUB, and their respective agents, employees, officers, directors, successors, and assigns, of and from any and all claims, demands, losses, expenses, damages, liabilities, actions, causes of action of any nature, including but not limited to personal injury, wrongful death and property damage, that in any manner arise from or relate to the operation of an ATV or UTV on HERMITAGE MEMBERS’ CLUB property. This waiver and release extends to and includes any and all claims, liabilities, injuries, damages, and causes of action that the parties do not presently anticipate, know, or suspect to exist, but that may develop, accrue, or be discovered in the future. I represent and warrant that I have considered the possibility that claims, liabilities, injuries, damages and causes of action may develop, accrue or be discovered in the future, and I voluntarily assume that risk as part of this agreement.

7. On behalf of myself and my children, any other minor for whom I am the guardian, and my heirs and successors in interest, I agree that I will not directly or indirectly institute any legal, equitable, administrative, or other action, complaint, or proceeding against the HAYSTACK RIDERS CLUB or the HERMITAGE CLUB, or their respective agents, employees, officers, directors, successors, and assigns, arising from or pertaining to the operation of an ATV or UTV on HERMITAGE MEMBERS’ CLUB property. This covenant applies and extends to any and all claims, liabilities, injuries, expenses, losses, damages, and causes of action that I do not presently anticipate, know, or suspect to exist, but that may develop, accrue, or be discovered in the future.

8. I agree to INDEMNIFY, DEFEND, PROTECT and hold the HAYSTACK RIDERS CLUB and the HERMITAGE MEMBERS’ CLUB, and their respective agents, employees, officers, directors, successors, and assigns, free and harmless from and against any and all claims, liabilities, penalties, losses, or expenses (including attorneys’ fees) for death of or injury to any person or damage to any property whatsoever arising from or caused in whole or in part, directly or indirectly, from the operation of any ATV or UTV registered in my name and bearing a HAYSTACK RIDERS CLUB decal on HERMITAGE MEMBERS’ CLUB property.

9. I have read, understand and fully agree to the terms of this waiver and release, and I have had the time and opportunity to discuss it with counsel. I understand and confirm that by signing this Member Agreement, I am giving up considerable future legal rights, and I am signing this Member Agreement freely, voluntarily, under no duress or threat of duress, and without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional waiver and release of all liability to the full extent of the law. I am 18 years of age or older and mentally competent to enter into this waiver.

Town of Wilmington Ordinance Regulations(Required)

I have read the Town of Wilmington Ordinance Regulations.

TOWN OF WILMINGTON ORDINANCE REGULATING ALL TERRAIN VEHICLES (ATVs) AND NEIGHBORHOOD ELECTRIC VEHICLES (NEVs)

SECTION 1. AUTHORITY. Under authority granted in 24 V.S.A. Chapter 59, 24 V.S.A. §§ 2291(4), and 23 V.S.A. $3510 the Selectboard of the Town of Wilmington hereby adopts the following civil ordinance regulating the time, manner, and location of operation of all-terrain and neighborhood electric vehicles within the Town.

SECTION 2. PURPOSE. The purpose of this Ordinance is to promote and protect the public health, safety and welfare of the Town, and to preserve residents' rights to peaceful and quiet enjoyment and protection of homes and properties by regulating and effectively enforcing the time, manner, and location of operation of all-terrain vehicles ("ATVS") and neighborhood electric vehicles ("NEVs") within the Town.

SECTION 3. DEFINITIONS.

A. "All-terrain vehicle," or "ATV," means any non-highway recreational vehicle, including all utility task vehicles except snowmobiles, having no less than two low pressure tires (25 pounds per square inch, or less), not wider than 64 inches with two- wheel ATVs having permanent, full-time power to both wheels, and having a dry weight of less than 2,500 pounds, when used for cross country travel on trails or on any one of the following or a combination thereof: land, water, snow, ice, marsh, swampland and natural terrain. An ATV on a public highway, road or legal trail shall be considered a motor vehicle and subject to municipal, state and federal laws as defined in 23 VSA §4. An ATV shall not include an electric personal assistive mobility device.

B. "Riding Club-sponsored Road" means a private road owned and controlled by the Hermitage Members Club, Inc. ("Hermitage") that permits the Haystack Riders Club LLC (“Club") passage on the private roads owned and controlled by the Hermitage,

C. "Enforcement Officer" means any law enforcement officer certified by the Vermont criminal justice training council.

D. "Operate" includes any attempt to operate and shall be construed to cover all matters and things connected with the presence and use of all-terrain vehicles on those public highways and private roads defined as public highways pursuant to statutory and common law listed in Section 4, paragraph D), below, whether they be in motion or at rest.

E. "Public highway" means any publicly accessible highway, road, or legal trail of any classification under the jurisdiction of the Town of Wilmington.

F. "Town" means Town of Wilmington or its legal representatives.

G. "Helmet" Protective headgear shall be the same standard quality as required and certified for the operation of motorcycles by the Commissioner of the Department of Motor Vehicles. The headgear shall be equipped with either a neck or chin strap.

Member Name(Required)

First Last

Member Signature(Required)

Authorized Users

Add Authorized Users(Required)

I authorize the following people, all of whom are licensed drivers aged 16 or older, to operate my ATV or UTV. I understand and agree that if I allow unauthorized persons to operate my ATV/UTV, HAYSTACK RIDERS CLUB reserves the right to terminate my membership and void my decal.

No

Yes

Authorized User 1

Authorized User Name 1(Required)

First Last

Age(Required)

16 or 17

18 or Older

Authorized User 1 - Haystack Riders Club Authorized Operator Agreement(Required)

In exchange for the privilege of operating an ATV or UTV on HERMITAGE MEMBERS’ CLUB property, I agree and affirm as follows:

1. I am authorized to operate an ATV/UTV registered in the HAYSTACK RIDERS CLUB.

2. While operating an ATV/UTV, I will follow and be bound by all HAYSTACK RIDERS CLUB rules, all HERMITAGE MEMBERS’ CLUB rules, and the Town of Wilmington ordinance regulating the use of ATVs or UTVs on public roadways.

3. I am a licensed driver, aged 16 or older.

4. I ACKNOWLEDGE, AGREE AND UNDERSTAND that the use of ATVs and UTVs may pose risks including injury to myself or others, disability, paralysis, or death, and other damages including damage to property belonging to me or to others. I expressly and voluntarily assume these risks, and agree to be held solely responsible for my own actions.

5. On behalf of myself and my spouse, children, any other minor for whom I am the guardian, and my heirs and successors in interest, I now and forever WAIVE, RELEASE, and DISCHARGE the HAYSTACK RIDERS CLUB, the HERMITAGE MEMBERS’ CLUB, and their respective agents, employees, officers, directors, successors, and assigns, of and from any and all claims, demands, losses, expenses, damages, liabilities, actions, causes of action of any nature, including but not limited to personal injury, wrongful death and property damage, that in any manner arise from or relate to the operation of an ATV or UTV on HERMITAGE MEMBERS’ CLUB property. This waiver and release extends to and includes any and all claims, liabilities, injuries, damages, and causes of action that the parties do not presently anticipate, know, or suspect to exist, but that may develop, accrue, or be discovered in the future. I represent and warrant that I have considered the possibility that claims, liabilities, injuries, damages and causes of action may develop, accrue or be discovered in the future, and I voluntarily assume that risk as part of this agreement.

6. On behalf of myself and my spouse, children, any other minor for whom I am the guardian, and my heirs and successors in interest, I agree that I will not directly or indirectly institute any legal, equitable, administrative, or other action, complaint, or proceeding against the HAYSTACK RIDERS CLUB or the HERMITAGE CLUB, or their respective agents, employees, officers, directors, successors, and assigns, arising from or pertaining to the operation of an ATV or UTV on HERMITAGE MEMBERS’ CLUB property. This covenant applies and extends to any and all claims, liabilities, injuries, expenses, losses, damages, and causes of action that I do not presently anticipate, know, or suspect to exist, but that may develop, accrue, or be discovered in the future.

7. I agree to INDEMNIFY, DEFEND, PROTECT and hold the HAYSTACK RIDERS CLUB and the HERMITAGE MEMBERS’ CLUB, and their respective agents, employees, officers, directors, successors, and assigns, free and harmless from and against any and all claims, liabilities, penalties, losses, or expenses (including attorneys’ fees) for death of or injury to any person or damage to any property whatsoever arising from or caused in whole or in part, directly or indirectly, from the operation of any ATV or UTV registered in my name and bearing a HAYSTACK RIDERS CLUB decal on HERMITAGE MEMBERS’ CLUB property.

8. I have read, understand and fully agree to the terms of this waiver and release. I understand and confirm that by signing this Member Agreement, I am giving up considerable future legal rights, and I am signing this Member Agreement freely, voluntarily, under no duress or threat of duress, and without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional waiver and release of all liability to the full extent of the law. I am 18 years of age or older and mentally competent to enter into this waiver.

Authorized User Name 1 Signature(Required)

Authorized User Name 1 Signature of Parent or Guardian(Required)

Add a 2nd authorized user?(Required)

No

Yes

Authorized User 2

Authorized User Name 2(Required)

First Last

Age(Required)

16 or 17

18 or Older

Authorized User 2 - Haystack Riders Club Authorized Operator Agreement(Required)

In exchange for the privilege of operating an ATV or UTV on HERMITAGE MEMBERS’ CLUB property, I agree and affirm as follows:

1. I am authorized to operate an ATV/UTV registered in the HAYSTACK RIDERS CLUB.

2. While operating an ATV/UTV, I will follow and be bound by all HAYSTACK RIDERS CLUB rules, all HERMITAGE MEMBERS’ CLUB rules, and the Town of Wilmington ordinance regulating the use of ATVs or UTVs on public roadways.

3. I am a licensed driver, aged 16 or older.

4. I ACKNOWLEDGE, AGREE AND UNDERSTAND that the use of ATVs and UTVs may pose risks including injury to myself or others, disability, paralysis, or death, and other damages including damage to property belonging to me or to others. I expressly and voluntarily assume these risks, and agree to be held solely responsible for my own actions.

5. On behalf of myself and my spouse, children, any other minor for whom I am the guardian, and my heirs and successors in interest, I now and forever WAIVE, RELEASE, and DISCHARGE the HAYSTACK RIDERS CLUB, the HERMITAGE MEMBERS’ CLUB, and their respective agents, employees, officers, directors, successors, and assigns, of and from any and all claims, demands, losses, expenses, damages, liabilities, actions, causes of action of any nature, including but not limited to personal injury, wrongful death and property damage, that in any manner arise from or relate to the operation of an ATV or UTV on HERMITAGE MEMBERS’ CLUB property. This waiver and release extends to and includes any and all claims, liabilities, injuries, damages, and causes of action that the parties do not presently anticipate, know, or suspect to exist, but that may develop, accrue, or be discovered in the future. I represent and warrant that I have considered the possibility that claims, liabilities, injuries, damages and causes of action may develop, accrue or be discovered in the future, and I voluntarily assume that risk as part of this agreement.

6. On behalf of myself and my spouse, children, any other minor for whom I am the guardian, and my heirs and successors in interest, I agree that I will not directly or indirectly institute any legal, equitable, administrative, or other action, complaint, or proceeding against the HAYSTACK RIDERS CLUB or the HERMITAGE CLUB, or their respective agents, employees, officers, directors, successors, and assigns, arising from or pertaining to the operation of an ATV or UTV on HERMITAGE MEMBERS’ CLUB property. This covenant applies and extends to any and all claims, liabilities, injuries, expenses, losses, damages, and causes of action that I do not presently anticipate, know, or suspect to exist, but that may develop, accrue, or be discovered in the future.

7. I agree to INDEMNIFY, DEFEND, PROTECT and hold the HAYSTACK RIDERS CLUB and the HERMITAGE MEMBERS’ CLUB, and their respective agents, employees, officers, directors, successors, and assigns, free and harmless from and against any and all claims, liabilities, penalties, losses, or expenses (including attorneys’ fees) for death of or injury to any person or damage to any property whatsoever arising from or caused in whole or in part, directly or indirectly, from the operation of any ATV or UTV registered in my name and bearing a HAYSTACK RIDERS CLUB decal on HERMITAGE MEMBERS’ CLUB property.

8. I have read, understand and fully agree to the terms of this waiver and release. I understand and confirm that by signing this Member Agreement, I am giving up considerable future legal rights, and I am signing this Member Agreement freely, voluntarily, under no duress or threat of duress, and without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional waiver and release of all liability to the full extent of the law. I am 18 years of age or older and mentally competent to enter into this waiver.

Authorized User Name 2 Signature(Required)

Authorized User Name 2 Signature of Parent or Guardian(Required)

Add a 3rd authorized user?(Required)

No

Yes

Authorized User 3

Authorized User Name 3(Required)

First Last

Age(Required)

16 or 17

18 or Older

Authorized User 3 - Haystack Riders Club Authorized Operator Agreement(Required)

In exchange for the privilege of operating an ATV or UTV on HERMITAGE MEMBERS’ CLUB property, I agree and affirm as follows:

1. I am authorized to operate an ATV/UTV registered in the HAYSTACK RIDERS CLUB.

2. While operating an ATV/UTV, I will follow and be bound by all HAYSTACK RIDERS CLUB rules, all HERMITAGE MEMBERS’ CLUB rules, and the Town of Wilmington ordinance regulating the use of ATVs or UTVs on public roadways.

3. I am a licensed driver, aged 16 or older.

4. I ACKNOWLEDGE, AGREE AND UNDERSTAND that the use of ATVs and UTVs may pose risks including injury to myself or others, disability, paralysis, or death, and other damages including damage to property belonging to me or to others. I expressly and voluntarily assume these risks, and agree to be held solely responsible for my own actions.

5. On behalf of myself and my spouse, children, any other minor for whom I am the guardian, and my heirs and successors in interest, I now and forever WAIVE, RELEASE, and DISCHARGE the HAYSTACK RIDERS CLUB, the HERMITAGE MEMBERS’ CLUB, and their respective agents, employees, officers, directors, successors, and assigns, of and from any and all claims, demands, losses, expenses, damages, liabilities, actions, causes of action of any nature, including but not limited to personal injury, wrongful death and property damage, that in any manner arise from or relate to the operation of an ATV or UTV on HERMITAGE MEMBERS’ CLUB property. This waiver and release extends to and includes any and all claims, liabilities, injuries, damages, and causes of action that the parties do not presently anticipate, know, or suspect to exist, but that may develop, accrue, or be discovered in the future. I represent and warrant that I have considered the possibility that claims, liabilities, injuries, damages and causes of action may develop, accrue or be discovered in the future, and I voluntarily assume that risk as part of this agreement.

6. On behalf of myself and my spouse, children, any other minor for whom I am the guardian, and my heirs and successors in interest, I agree that I will not directly or indirectly institute any legal, equitable, administrative, or other action, complaint, or proceeding against the HAYSTACK RIDERS CLUB or the HERMITAGE CLUB, or their respective agents, employees, officers, directors, successors, and assigns, arising from or pertaining to the operation of an ATV or UTV on HERMITAGE MEMBERS’ CLUB property. This covenant applies and extends to any and all claims, liabilities, injuries, expenses, losses, damages, and causes of action that I do not presently anticipate, know, or suspect to exist, but that may develop, accrue, or be discovered in the future.

7. I agree to INDEMNIFY, DEFEND, PROTECT and hold the HAYSTACK RIDERS CLUB and the HERMITAGE MEMBERS’ CLUB, and their respective agents, employees, officers, directors, successors, and assigns, free and harmless from and against any and all claims, liabilities, penalties, losses, or expenses (including attorneys’ fees) for death of or injury to any person or damage to any property whatsoever arising from or caused in whole or in part, directly or indirectly, from the operation of any ATV or UTV registered in my name and bearing a HAYSTACK RIDERS CLUB decal on HERMITAGE MEMBERS’ CLUB property.

8. I have read, understand and fully agree to the terms of this waiver and release. I understand and confirm that by signing this Member Agreement, I am giving up considerable future legal rights, and I am signing this Member Agreement freely, voluntarily, under no duress or threat of duress, and without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional waiver and release of all liability to the full extent of the law. I am 18 years of age or older and mentally competent to enter into this waiver.

Authorized User Name 3 Signature(Required)

Authorized User Name 3 Signature of Parent or Guardian(Required)

Proof of Insurance & Registration

The insurance certificate must name “Hermitage Members Club Inc.” and “Haystack Riders Club LLC” as additional insureds.

ATV/UTV - Proof of Insurance(Required)

Max. file size: 50 MB.

ATV/UTV - Proof of Registration(Required)

Max. file size: 50 MB.

Add a 2nd ATV/UTV?(Required)

No

Yes

ATV/UTV 2 - Proof of Insurance(Required)

Max. file size: 50 MB.

ATV/UTV 2 - Proof of Registration(Required)

Max. file size: 50 MB.

Add a 3rd ATV/UTV?(Required)

No

Yes

ATV/UTV 3 - Proof of Insurance(Required)

Max. file size: 50 MB.

ATV/UTV 3 - Proof of Registration(Required)

Max. file size: 50 MB.

Add a 4th ATV/UTV?(Required)

No

Yes

ATV/UTV 4 - Proof of Insurance(Required)

Max. file size: 50 MB.

ATV/UTV 4 - Proof of Registration(Required)

Max. file size: 50 MB.

Registration

ATV/UTV Registration(Required)

Price:

2nd ATV/UTV Registration

Price:

3rd ATV/UTV Registration

Price:

4th ATV/UTV Registration

Price:

Total

Comments

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