Loading...

RELEASE AND HOLD HARMLESS AGREEMENT

WHEREAS, the UNDERSIGNED acknowledges the inherent risks involved in riding and working around horses, which risks include bodily injury from using, riding or being in close proximity to horses, among other risks, and further, that both horse and rider can be injured in normal use or in competition and schooling;

I understand that it is my responsibility to wear the appropriate equestrian equipment, as well as protective equipment, included by not limited to helmet and boots;

IN CONSIDERATION, therefore, for the privilege of taking riding lessons and/or working around horses at Flintrock Stables, located at 16 East Brubaker Valley Road, Lititz, PA 17543, the Undersigned does hereby agree to hold harmless and indemnify Flintrock Stables LLC, Flintrock Corporation, Flintrock Farms, Daniel Heller, Jennifer Heller, and all associates of Flintrock, and further release them from any liability or responsibility for accident, damage, injury, or illness to the undersigned or any horse owned by the undersigned or any family member or spectator accompanying the Undersigned.

I also hearby grant Flintrock Stables permission to use my and/or my child’s photo and name for the purpose of promotional material, website, and/or social media content.



First Rider's Name

First Name*

Last Name*

Phone*
First Rider's Age Acknowledgment*
First Rider's Date of Birth*
I certify that I am 18 years of age or older
First Rider's Signature*
Second Rider's Name

First Name*

Last Name*
Second Rider's Date of Birth*
Third Rider's Name

First Name*

Last Name*
Third Rider's Date of Birth*
Fourth Rider's Name

First Name*

Last Name*
Fourth Rider's Date of Birth*
Fifth Rider's Name

First Name*

Last Name*
Fifth Rider's Date of Birth*
Sixth Rider's Name

First Name*

Last Name*
Sixth Rider's Date of Birth*
Seventh Rider's Name

First Name*

Last Name*
Seventh Rider's Date of Birth*
Eighth Rider's Name

First Name*

Last Name*
Eighth Rider's Date of Birth*
Ninth Rider's Name

First Name*

Last Name*
Ninth Rider's Date of Birth*
Tenth Rider's Name

First Name*

Last Name*
Tenth Rider's Date of Birth*
Parent or Guardian's Email Address

Email*

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


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also 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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!