Loading...

RELEASE FOR RIDING STUDENTS AND CAMP PARTICIPANTS

The undersigned participant, and his or her parent or legal guardian if the participant is under the age of 18 years, does/do hereby execute this release, waiver, and indemnification for himself or herself/themselves and his or her/their heirs, successors, representatives, and assigns and, thereby, agree(s) and represents as follows:

To release Montanova Stables, its directors, members, employees, agents, representatives from any and all liability, loss, damage, costs, claims, and/or causes of action, including but not limited to all bodily injuries and property damage arising out of participation in the activity, it being specifically understood that said activity includes the handling of equine by the undersigned participant. The undersigned person(s) further agree(s) to indemnify Montanova Stables, its directors, members, employees, agents, representatives and hold them harmless for any liability, loss, damage, cost, claim judgment, or settlement which may be brought or entered against them as a result of the undersigned person’s participation in said activity.

Pursuant to Section 3.2-6202 of the Code of Virginia (as amended) the undersigned(s) execute(s) this waiver of the undersigned(s) rights to sue and agree(s) to assume all risks resulting from the “intrinsic dangers of equine activities”. “Intrinsic dangers of equine activities” is defined as those dangers or conditions that are an integral part of equine activities, including but not limited to, (i) the propensity of equines to behave in ways that may result in injury, harm, or death to persons on or around them; (ii) the unpredictability of an equine’s reaction to such things as sounds, sudden movement, and unfamiliar objects, persons, or other animals; (iii) certain hazards such as surface and subsurface conditions; (iv) collisions with other animals or objects; and (v) the potential of a participant acting in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the equine or not acting within the participant’s ability.

This waiver shall remain valid unless expressly revoked by the participant or Parent or guardian of a minor. The revocation shall be in writing which shall be delivered to the provider and shall become effective thirty (30) days after delivery to the provider.

The undersigned(s) shall maintain all medical and health insurance needed to cover all risks of any kind in any place in livestock, equine, and/or other activities. In the event of injury, the undersigned (and parent/guardian of rider or handler if a minor) consents to any medical care that may be rendered to the rider or handler under the instructions of any physician or hospital. It is understood that this consent is given in advance of any diagnosis or treatment which may be required, and is given to enable Montanova Stables Foundation, its employees, agents, independent contractors, and the hospital staff and physicians, to exercise their best judgment as to the necessity for and requirements of diagnosis and treatment. The undersigned (parent/guardian of the rider or handler if a minor) agrees to pay all fees for doctors, hospitals, ambulances, and other medical charges incurred. 

I, the undersigned participant, will wear and use, in accordance with Montanova Stables's policy and procedure, all safety equipment and ensure personal equipment is in good condition at all times.

By signing this waiver you also agree to our Lesson Policies and fees, detailed below.

Standard Lesson - $60 each 

Private Lesson - $80 each 

Hack Fee - $30 (each occurrence)

Scholarships are available based on family need


In an effort to avoid financial misunderstandings and to teach students to attend lessons regularly, be punctual, and to meet our scheduling needs we implement the following (please initial indicating your understanding of each paragraph):


Lesson payments for the month are due in advance or payment at the time of service is also acceptable.


 

Payment in full will be expected for lessons canceled within 24 hours of designated lesson time. 


 

Students should arrive 30 minutes prior to their scheduled lesson time in order to be ready on time. 


 

During inclement weather, driving conditions permitting, we will offer indoor lessons on horsemanship. 


 

If we must cancel a lesson for some reason, we will text the number you have provided.


 

You may contact us via email at jeng1962@gmail.com or by phone at or (434) 996-8089 (cell so can text).



First Rider Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Rider Date of Birth*
EMERGENCY INFORMATION

Please list ALL allergies or medical conditions *
Below, please provide an emergency contact OTHER than the rider or guardian completing this form.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Rider 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:*
Media Release
Do you give permission for images of yourself or your child to be used in promotional materials for MSF, including website, brochures, and social media?*
No
Yes
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!