ࡱ > q` # bjbjqPqP 7b : : 8 8 L @ f " m o o o o o o $ T" h $ f m m @h p 9 4 0 "% "% "% 1 X Desert Trails Horsemanship RIDER REGISTRATION FORM CONFIDENTIAL Please print & complete all boxesFirst name of rider(s): Last Name:Address:Email of responsible party: Phone (Home):Phone (Cell):Would you like to receive a monthly email newsletter? _____________ YES ____________ NODate of birth:Age:Weight:Height:Have you suffered serious injury while riding?YES NO If yes, please describe: Please detail any disability or medical condition that may affect your ability to ride or which your instructor should be aware of in case of emergency (e.g. back problems, diabetes, pregnancy) How did you hear about Desert Trails Horsemanship? EMERGENCY CONTACTName:Phone No:RIDING ABILITIES Check all boxes that applyI consider rider to be a:How many times has rider ridden in the last 12 months?Complete beginner Advanced Beginner None Less than 12 Novice Intermediate Advanced 12 40 40+ What do you believe your capabilities on a horse / pony to be?Riding at a walk Trotting with stirrups Trotting without stirrups CanteringRiding over jumps up to (1 8) Riding over jumps (2 6) I Acknowledge THAT RIDING IS A RISK SPORT AND HOLDS A POTENTIAL DANGER, and that all horses may react unpredictably on occasions. I understand that I must obey the instructions of the instructor and must comply with health & safety requirements of the establishment. I confirm that to the best of my knowledge all the above details are correct. The parent or guardian of riders under the age of 18 must sign this form. I have read and understand the lesson and booking cancellation policy and agree to abide by it at all times. RIDERS AGED 18YRS OR OVER: I confirm that the above pre-assessed abilities are correct and I agree that I ride entirely at my own risk.. RIDERS UNDER 18YRS OF AGE: I accept full responsibility for my child and confirm that the above pre-assessed abilities are correct.If signing on behalf of rider please state your relationship to rider:Signature : Print name:Date: Desert Trails Horsemanship HORSEBACK RIDING RELEASE OF LIABILITY AND INDEMNITY AGREEMENT I, ____________________________________(print name) , hereby acknowledge that I and/or my legal guardian on my behalf have voluntarily registered to participate in an activity of horseback riding with Desert Trails Horsemanship/ Eidson Ranch, et al. I fully understand that the activity of horseback riding, or even being near a horse, involves numerous dangers and risks of injury to me. I acknowledge that the assumption of all the risks involved is my responsibility and I completely release Desert Trails Horsemanship/ Eidson Ranch, et al, its agents, instructors, and property from all liability for any and all injuries caused by my participation in the general activity of horseback riding. Please initial to show that you agree_____. I fully understand that an animal (horse) irrespective of its training and usual past behavior and characteristics, may act or react unpredictably based on instinct or fright, and that even the most gentle horse, when provoked or frightened, may rear, buck, run away or otherwise act in an unpredictable and dangerous manner. In addition, weather such as thunder, hail, lightening, or rain, may cause a horse to rear, buck, run away or otherwise act in an unpredictable and dangerous manner. Having understood these dangers, I fully assume all of the risks involved and completely release Desert Trails Horsemanship/ Eidson Ranch, et al, its agents, instructors, and property from liability for any and all injuries to me from the general activity of horseback riding. Please initial to show that you agree_____. I fully understand that riding on ANY type of terrain can be dangerous to my horse and me and that this danger increases when riding a horse fast, such as at a canter (lope), jumping, or at a gallop. Under these conditions, or even while riding at a slower pace, my horse may stumble, be thrown off balance, get caught in a hole or rut, fall, or otherwise be dangerous to me. I also fully understand that I may, at any time, lose control of and/or fall off my horse, or have a collision. I fully assume the responsibility for all of these dangers and risks, and completely release Desert Trails Horsemanship/ Eidson Ranch, et al, its agents, instructors, and property from all liability for any and all injuries to me from the dangers and risks as stated above. Please initial to show that you agree______. I fully understand that animals (horses) and conditions are unpredictable and that the risk of injury or death is inherent to the activity of horseback riding and/or being around horses. I fully assume the responsibility for the risk of injury or death caused by my contact with horses and horseback riding. I completely release Desert Trails Horsemanship/ Eidson Ranch, et al, its agents, instructors, and property from any and all liability for any and all injuries or death to me caused by my contact with horses and/or horseback riding. Please initial to show that you agree______. I agree not to sue, claim against, attach the property of or prosecute Desert Trails Horsemanship/ Eidson Ranch, et al, its officers, board members, affiliated organizations, agents and/or its employees for riding and its related activities, whether or not such injury or death was caused by their negligence or from any other cause. Please initial to show that you agree______. I agree to defend, indemnify and hold harmless Desert Trails Horsemanship/ Eidson Ranch, et al and all of its officers, board members, affiliated organizations, agents and employees for any injury or death caused by or resulting from my participation in the activity of horseback riding and its related activities, whether or not such injury or death was caused by their negligence or from any other cause. Please initial to show that you agree______. This agreement shall be legally binding upon me, my family, my heirs, my estate, assigns, legal guardians, and my personal representatives. Please initial to show that you agree______. I have carefully read this agreement and fully understand its contents. I am aware that I am releasing certain legal rights that I otherwise may have and I enter into this release of liability and indemnity agreement on behalf of myself of my own free will. Please initial to show that you agree______. THIS IS A RELEASE OF LIABILITY. DO NOT SIGN OR INITIAL THE RELEASE IF YOU DO NOT UNDERSTAND AND/OR AGREE WITH ITS TERMS. Participants under 18 years of age require the signature of a parent or legal guardian. Signature of Participant, Parent /Legal Guardian: ____________________________________Date:_______________ PAGE Page - PAGE 2 - of 2 09/10 * B C Y a s t u ɻɯɡzoaSIS hP> CJ OJ QJ hG0 hP> 5CJ OJ QJ hG0 h9| 5CJ OJ QJ h9| 5CJ OJ QJ h