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Agreement for Acceptance of Risk and Waiver of Liability

All riders must complete this form before their first lesson. 

On my behalf and on behalf of any minor children participating in these activities for whom I am legally responsible for, I agree to the following:

I acknowledge the risks involved in riding and working around horses, which include bodily injury from riding, grooming or being in close proximity to horses. In addition, it is my clear understanding that both horse and rider can be injured in normal daily activities as well as during show and competition and that no amount of caution, experience or instruction can eliminate all risk.

The undersigned hereby agrees to hold harmless and indemnify farm and owner Raynham Stables, Lindsay Mahon AND/OR any Staff or Volunteers and further release from any and all liability or responsibility from accident, property damage, injury or even death, to the undersigned or to any family member or spectator accompanying the undersigned on the premises of Raynham Stables due to any cause whatsoever.

I acknowledge that I have read and fully understand and agree to the terms and conditions stated herein and that it is binding upon my next of kin, heirs, executors, administrators, assigns and/or representatives. I have read and understand the rules required to ride at Raynham Stables.

 

PHOTO RELEASE

I grant to Raynham Stables, its representatives and employees the right to take photographs of me or my child while participating in lessons or programs with Raynham Stables. I authorize Raynham Stables, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree Raynham Stables may use such photographs of me or my child with or without my name and for any lawful purpose, including for example such purposes as publicity, advertising, and web content.

I Agree

First Rider's Name

First Name*

Last Name*

Phone*
First Rider's Date of Birth*
I certify that I am 18 years of age or older
First Rider's Medical Information
Do you have any allergies? If yes, please list below.*
No
Yes

Allergies:
Do you carry an epi-pen?
Yes
No

Please list any medical conditions we should be aware of:
First Rider's Signature*
Second Rider's Name

First Name*

Last Name*
Second Rider's Date of Birth*
Second Rider's Medical Information
Do you have any allergies? If yes, please list below.*
No
Yes

Allergies:
Do you carry an epi-pen?
Yes
No

Please list any medical conditions we should be aware of:
Third Rider's Name

First Name*

Last Name*
Third Rider's Date of Birth*
Third Rider's Medical Information
Do you have any allergies? If yes, please list below.*
No
Yes

Allergies:
Do you carry an epi-pen?
Yes
No

Please list any medical conditions we should be aware of:
Fourth Rider's Name

First Name*

Last Name*
Fourth Rider's Date of Birth*
Fourth Rider's Medical Information
Do you have any allergies? If yes, please list below.*
No
Yes

Allergies:
Do you carry an epi-pen?
Yes
No

Please list any medical conditions we should be aware of:
Fifth Rider's Name

First Name*

Last Name*
Fifth Rider's Date of Birth*
Fifth Rider's Medical Information
Do you have any allergies? If yes, please list below.*
No
Yes

Allergies:
Do you carry an epi-pen?
Yes
No

Please list any medical conditions we should be aware of:
Sixth Rider's Name

First Name*

Last Name*
Sixth Rider's Date of Birth*
Sixth Rider's Medical Information
Do you have any allergies? If yes, please list below.*
No
Yes

Allergies:
Do you carry an epi-pen?
Yes
No

Please list any medical conditions we should be aware of:
Seventh Rider's Name

First Name*

Last Name*
Seventh Rider's Date of Birth*
Seventh Rider's Medical Information
Do you have any allergies? If yes, please list below.*
No
Yes

Allergies:
Do you carry an epi-pen?
Yes
No

Please list any medical conditions we should be aware of:
Eighth Rider's Name

First Name*

Last Name*
Eighth Rider's Date of Birth*
Eighth Rider's Medical Information
Do you have any allergies? If yes, please list below.*
No
Yes

Allergies:
Do you carry an epi-pen?
Yes
No

Please list any medical conditions we should be aware of:
Ninth Rider's Name

First Name*

Last Name*
Ninth Rider's Date of Birth*
Ninth Rider's Medical Information
Do you have any allergies? If yes, please list below.*
No
Yes

Allergies:
Do you carry an epi-pen?
Yes
No

Please list any medical conditions we should be aware of:
Tenth Rider's Name

First Name*

Last Name*
Tenth Rider's Date of Birth*
Tenth Rider's Medical Information
Do you have any allergies? If yes, please list below.*
No
Yes

Allergies:
Do you carry an epi-pen?
Yes
No

Please list any medical conditions we should be aware of:
Rider's 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*
Please register for our email list for updates and barn announcements!
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone 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 Medical Information
Do you have any allergies? If yes, please list below.*
No
Yes

Allergies:
Do you carry an epi-pen?
Yes
No

Please list any medical conditions we should be aware of:
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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