Riding Instruction And Liability Release Form For Individuals printable pdf download

RIDING INSTRUCTION AND LIABILITY RELEASE FORM FOR INDIVIDUALS

THIS FORMMUSTBE COMPLETED BYANDFOR EACHPARTICIPANT.

PLEASEREADCAREFULLY BEFORESIGNING.SERIOUSINJURYMAY RESULTFROMYOUR PARTICIPATION IN THIS ACTIVITY.

THIS STABLEDOESNOTGUARANTEE Y OURSAFETY.

Circle Lake Ranch. Inc., Paula Layne Spltzenberger, Garry Pierre Oubre, Lacey Lea Spltzenberger, Pony Productions, Inc.,

and all employees, oftlcers or contract laborers are hereinafter known as "THIS STABLE".

RIDERNAME:

AGE(IF UNDER 21):

Weight over 180 lbs?

YES

NO(Our horses are capable of only carrying a rider up to 180 lbs)

Horse Riding Experience:

Under 10 hours

Over 10 hours

Does this rider have any physical and/or mental health conditions, problems, disorders, and/or dlsabillties with special needs

which may affect his/her safety and abillty to ride a horse? __

If "Yes", please here and advise this stable prior to riding

of how we may assist you with any special

needs:

ACCIDENTIMEDICAL

INSURANCE - I AGREETHAT:Should emergency medical treatment be requIred, I and/or my own

accldentJmedicallnsurance

company shall pay for all such Incurred expenses.

Health Insurance Company:

Group Number:

Plan or Identification Number:

Both Parents Must InItial Below for Each Paragraph:

REGISTRATION OFRIDERSANDAGREEMENT PURPOSE- In consideration of payment of a fee and the signing of this agreement, I, the following

Ilsted individual, and the parent or legal guardlan(s) thereof If a minor, do hereby voluntarily request and agree to participate In riding Instruction as a

student at THIS STABLE,and that this student will either ride hlslber own horse, or school horses provided by THIS STABLEfor Instructional purpose, today

and on all future dates.

AGREEMENT SCOPEANDTERRITORYANDDEFINITIONS - This agreement sball be legally binding upon me, the registered student, and the

parents or legal guardian thereof. If a minor, my heirs, estate, assigns, including all minor cblldren. and personal representatives;

and It shall be

Interpreted according to the laws of the state and county of THIS STABLE'Sphysical location. If any clause, phrase, or word Is In confllct with state law then

that single part Is null and void. The term "HORSE"herein sball refer to all equine species. The term "HORSEBACK RIDING"herein sball refer to riding or

otherwise handl1ng of horses, ponies, mules or donkeys, whether from the ground or mounted. The terms "STUDENT"and/or "RIDER" sball herein refer to a

person who rides a horse mounted or otherwise handles or comes near a horse from the ground. The terms "I", "ME", "MY" shall herein refer to the above

registered student rider and the parents or legal guardians thereof If a minor.

ACTIVITY RISKCLASSIFICATION - I UNDERSTAND T HAT:Horseback riding Is classified as a RUGGED ADVENTURE RECREATIONAL S PORT

ACTIVITY and that there are numerous obvious and non· obvious Inherent risks always present In such activity despite all safety precautions.

According to

NEISS(National Electronic Injury Surveillance systems of United States Consumer Products) horse activities rank approximately 64'" among the activities of

people relative to injuries that result In a stay at U.s. Hospitals. Related injuries can be severe requiring more hospital days and resulting In more lasting

residual effects than injuries In other activities.

NATUREOFTHIS STABLE'SSCHOOL HORSES-I UNDERSTAND T HAT:THIS STABLEchooses Its school horses for their calm dispositions and

sound basic training as Is required for use for STUDENT RIDERS,and THIS STABLEfollows a rigid safety program. Yet, no riding horse Is a completely safe

horse. Horses are 5 to 15 times larger, 20 to 40 times more powertul, and 3 to 4 times faster than a human. If a rider falls from horse to ground It will

generally be at a distance of from 3 ~ feet to 5 ~ feet, and the Impact ay result In Injury to the rider. Horseback riding Is the only sport where one much

smaller, weaker predator animal (human) tried to Impose Its will on, and become one unit with. another much larger, stronger prey animal with a mind of Its

own (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, changing directions or speed at will; shlftJng Its weight; bucking;

rearing; kicking; biting; or running from danger.

RIDERRESPONSIBILITY -I UNDERSTAND T HAT: Upon mounting a horse and taking up the reins the rider Is In primary control of the horse.

The rider's safety largely depends upon bIsIher ablllty to carry out simple Instructions, and hlslber ablllty to remain balanced aboard the moving animal

agree that the rider sball be responsible for hlslber own safety,lncludlng

that of an unborn cblld, If the rider Is pregnant

Pregnant women should ride

horses only under the advice of their physician. THIS STABLEadvises pregnant women not to ride horses.

CONDITIONS O FNATURE ANDINSPECTION OFPREMISES-I UNDERSTAND T HAT: THIS STABLEIs not responsible for total or partial acts,

occurrences, or elements of nature that can scare a horse, cause It to faJJ, or react In some other unsafe way. SOMEEXAMPLES ARE: Thunder, Ilghtnlng,

rain, wind, wild and domestic animals, Insects, reptiles, which may walk, run or fly near or bite and 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.

The rider and parent or legal guardian have Inspected THIS STABLE'Sfaclllties and are satisfied that all premise conditions are reasonably safe

for rider's Intended purpose, usage and presence upon THIS STABLE'SPREMISES.

SADDLE GIRTH'SNATURAL LOOSENING -I UNDERSTAND THAT:Saddle girths (saddle fasteners around horse's belly) may loosen during a ride.

If a rider notices this he/she must alert the riding Instructor as quickly as possible so action can be taken to avoid sUppage of saddle and a potential fall

from the animaL

PROTECTIVE HEADGEAR WARNING -I AGREETHAT:I have been fully warned and advised by this stable that I should purchase and wear

protective headgear of a quallty not less than SEI CERTIFIEDASTMSTANDARD Fl163 Equestrian RIding Helmet wblle riding, being and working around

horses. I do understand that the wearing of such headgear while mounting, riding, dismounting and otherwise being around horses, may prevent or reduce

severity of some of the headgear wearer's head injuries and may even prevent the wearer's death from happening as the result of a fall from a horse or

other occurrence.

Riders under 18 years of age are required to use proper equestrian helmets while mounted at THIS STABLE.