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Riding lnstruction Agreement and Liability Release Form for lndividuals
This form must be completed by and for each participant
Hooves for Harmonv, lnc

Hooves for Harmony, hereinafter known as "this stable"
Location or Address: 885 Sutro Ave Novato, CA 94947
PLEASE READ CAREFULLY BEFORE SIGNING

SERIOUS INJURY MAY RESULT FROM YOUR PARTICIPATING IN THIS ACTIVITY. THIS STABLE DOES NOT GUARANTEE YOUR SAFETY.

A. REGISTRATION OF RIDERS AND AGREEMENT PURPOSE: ln consideration of the payment of a fee and the signing of this agreement, l, the following listed individual, and the parent or legal guardians thereof if a minor, do hereby voluntarily request and agree to participate in therpeutic riding as a student at this stable and that this student will ride a therapy horse provided by this stable for instructional purpose, today and on all future dates:

B. AGREEMENT SCOPE AND TERRITORY AND DEFINITIONS:This agreement shall be legally binding upon me the registered student , and the parents or legal guardians thereof is a minor, 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 stable’s physical location.  Any disputes by the rider shall be litigated in, and venue shall be the county in which this stable is physically located.  If any clause, phrase, or word is in conflict with state law, then that single part is null and void.  The term “horse” herein shall refer to all equine species.  The term “horseback riding” herein shall refer to riding or otherwise handling of horses, ponies, mules, or donkeys, whether from the ground or mounted.  The terms “student” and/or “rider” shall 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”, or “my” shall herein refer to the above registered student rider and the parents or legal guardians thereof if a minor.

C. ACTIVITY RISK CLASSIFICATION: I UNDERSTSAND THAT: Horseback riding is classified as RUGGED ADVENTURE RECREATIONAL SPORT ACTIVITY, and that there are numerous obvious and non-obvious inherent risks always present in such activities despite all safety precautions.  According to NEISS (National Electronic Injury Surveillance Systems of the United States Consumer Products) horse activities rank approximately 64th 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.

D. NATURE OF THIS STABLE’S SCHOOL HORSES: I UNDERSTAND THAT: This stable chooses its school horses for their calm dispositions and sound basic training as is required for use for student riders, and this stable follows 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 powerful, and 3 to 4 times faster than a human.  If a rider falls from horse to ground it will generally be at a distance from 3 ½ to 5 ½ feet, and the impact may 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 of movement 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, shifting its weight, bucking, rearing, kicking, biting, or running from danger.

E. RIDER RESPONSIBILITY I UNDERSTAND THAT: 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 his/her ability to carry out simple instructions, and his/her ability to remain balanced aboard the moving animal. I agree that the rider shall be responsible for his/her own safety including that of an unborn child, if the rider is pregnant. Pregnant women should ride horses only at the advice of their physician. This stable advises pregnant women not to ride horses.

F. CONDITIONS OF NATURE AND INSPECTION OF PREMISES I UNDERSTAND THAT: this stable is NOT RESPONSIBLE FOR TOTAL OR PARTIAL ACTS, OCCURANCES, OR ELEMENTS OF NATURE THAT CAN SCARE A HORSE, CAUSE IT TO FALL, OR REACT IN SOME OTHER UNSAFE WAY. SOME EXAMPLES ARE: Thunder, lightning, rain, wind and 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 a subject of constant change in condition according to the weather, temperature, and natural and man-made changes in landscape. The rider and parent or legal guardian have inspected this stables facilities and are satisfied that all premise conditions are reasonably safe for the rider’s intended purpose, usage and presence upon this stables premises.

G. SADDLE GIRTHS/NATURAL LOOSENING I UNDERSTAND THAT: saddle girths (saddle fasteners around the horse’s belly) may loosen during a ride. If a rider/parent notices this he/she must alert the riding instructor as quickly as possible so action may be taken to avoid slippage of saddle and a potential fall from the animal.

H. ACCIDENT/MEDlCAL lNSURANGE I AGREE THAT: Should emergency medical treatment be required. I and/or my own accident/medical insurance company shall pay for all such incurred expenses. 

l. PROTECTIVE HEADGEAR WARNING I AGREE THAT: I for myself and on behalf of my child and/or legal ward have been fully warned and advised by this stable that protective headgear which meets or exceeds the quality standards of the SEI CERTIFIED ASTM STANDARD F 1163 EQUESTRIAN HELMET should be worn while riding and being near horses and I do understand that the wearing of such headgear at these times may reduce severity of some of the wearer's head injuries and possibly prevent the wearer's death from happening as the result of a fall or other occurrences.

J. LlABlLlTY RETEASE I AGREE THAT: ln consideration of this stable allowing my participation in any activity, under the terms set forth herein. l, the rider/visitor, for myself and on behalf of my child and/or legal ward, heirs, administrators, personal representatives or assigns, do agree to hold harmless, release, and discharge this stable, its owners, agents, employees, volunteers, officers, directors, representatives. assigns, members, owner of the horse, owners of premises, and trails, affiliated organizations, and lnsurers and others acting on its 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 stables and/or its associates ordinary negligence, and I do further agree that except in the event of this stables gross negligence and willful and wanton misconduct, I shall not bring any claims, demands, legal actions and causes of action against this stable and its associates as stated above in this clause, for any economic and non-econornic losses due to bodily injury, death, property damage sustained by me and/or my minor child or legal ward in relation to the premises and operations of this stable, to include but not limited to riding, handling or otherwise being near horses owned by or in the care, custody and control of this stable, or for any other injury or loss sustained while on the premises, related to horses or not, or while riding my own horse or a school horse, whether on or off the premises of this stable.

ALL RIDERS AND PARENTS OR LEGAL GUARDIANS MUST SIGN BETOW AFTER READING THIS ENTTRE DOCUMENT SIGNER STATEMENT OF AWARENESS: I/WE THE UNDERSIGNED, HAVE READ AND DO UNDERSTAND THE FOREGOING AGREEMENT WARNINGS, RELEASE AND ASSUMPTION OF RISK. I/WE FURTHER ATTEST THAT ALL FACTS RELATING TO THE APPTICANTS PHYSICAL CONDITION, EXPERIENCE AND AGE ARE TRUE AND ACCURATE

Release Form for Media Recording

I, the undersigned, do hereby consent and agree that Hooves for Harmony, its employees, or agents have the right to take photographs, videotape, or digital recordings of me or the minor I am signing for and to use these in any and all media, now or hereafter known, and exclusively for the purpose of promoting the program and raising funds for the program. I futher consent that my name, or the minor's name for whom I am signing, and identity may be revealed therein or by descriptive text or commentary.

I do hereby release to Hooves for Harmony, Inc., its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.

I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.

I also understand that Hooves for Harmony, Inc. is not responsible for any expense or liability incurred as a result of my pafticipation in this recording, including medical expenses due to any sickness or injury incurred as a result.

I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement. If under 18 years of age, a parent or legal guardian must sign.

Today's Date: June 7, 2020

First Participants Name

First Name*

Last Name*

Phone*
First Participants Date of Birth*
I certify that I am 18 years of age or older
First Participants Information

Other Siblings:
First Participants Signature*
Second Participants Name

First Name*

Last Name*
Second Participants Date of Birth*
Second Participants Information

Other Siblings:
Third Participants Name

First Name*

Last Name*
Third Participants Date of Birth*
Third Participants Information

Other Siblings:
Fourth Participants Name

First Name*

Last Name*
Fourth Participants Date of Birth*
Fourth Participants Information

Other Siblings:
Fifth Participants Name

First Name*

Last Name*
Fifth Participants Date of Birth*
Fifth Participants Information

Other Siblings:
Sixth Participants Name

First Name*

Last Name*
Sixth Participants Date of Birth*
Sixth Participants Information

Other Siblings:
Seventh Participants Name

First Name*

Last Name*
Seventh Participants Date of Birth*
Seventh Participants Information

Other Siblings:
Eighth Participants Name

First Name*

Last Name*
Eighth Participants Date of Birth*
Eighth Participants Information

Other Siblings:
Ninth Participants Name

First Name*

Last Name*
Ninth Participants Date of Birth*
Ninth Participants Information

Other Siblings:
Tenth Participants Name

First Name*

Last Name*
Tenth Participants Date of Birth*
Tenth Participants Information

Other Siblings:
Participants Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Other Siblings:
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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