Student's Name *

First Name

Last Name

Emergency Contact Name *

First Name

Last Name

Emergency Phone *

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Phone *

(###)

###

####

Consent Plan *

In the event that emergency medical aid/treatment is required due to illness or injury during center activities, or while on the property where the agency conducts its business, I authorize Amazing Equine Adventures to: 1. Secure and maintain medical treatment and transportation, if needed. 2. Release participant records upon request to the authorized individual or agency involved in the medical emergency treatment. This authorization includes x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “lifesaving” by the physician. This provision will only be invoked if the person(s) above is unable to be reached.

I understand & consent

Parent or legal guardain *

By typing your name at the end of a document can count as a signature.

First Name

Last Name

Today's Date *

MM

DD

YYYY

RELEASE AND HOLD HARMLESS AGREEMENT *

No student will be accepted for equine assisted activities and/or horsemanship instruction and no volunteer accepted for service at AMAZING HORSE ADVENTURES until this form has been READ, UNDERSTOOD, COMPLETED AND SIGNED by the parent(s) or guardian(s) of a minor or, if the student or volunteer is of legal age and sound mind, by the student or volunteer. Although participation in the program is under strict supervision and every effort is made to avoid injury or accident, the undersigned acknowledges the inherent risks involved in riding, driving, and working around horses. This includes bodily injury from horseback riding or driving or being in close proximity to horses. Among other risks, both horse and rider can be injured during normal use or in competition and schooling. IN CONSIDERATION for the privilege of riding, driving and/or working around horses at AMAZING HORSE ADVENTURES the undersigned, as self, or as parent(s), or guardian(s) of the named minor, jointly or severally, do hereby agree to release, hold harmless and indemnify AMAZING HORSE ADVENTURES, its officers, directors, trustees, agents, employees, representatives, successors and assigns from all manner of liability, loss, costs, claims, demands and damages of every kind and nature whatsoever, including but not limited to reasonable attorney’s fees, which the undersigned or said minor may now or in the future have against AMAZING HORSE ADVENTURES, its officers, directors, trustees, agents, employees, representatives, successors and assigns, on account of any accident, damage, injury or illness, physical or mental condition, known or unknown, to the undersigned or said minor, or the treatment thereof, arising as a result of, or in any way connected to, acts or incidents occurring at or relating to AMAZING HORSE ADVENTURES, its officers, directors trustees, agents, employees, representatives, successors or assigns, including but not limited to their negligence or gross negligence in rendering the services described above or in any way incidental thereto. I have carefully read this agreement and fully understand its contents. By typing your name at the end of a document can count as a signature

I understand and agree.

Parent or legal guardain *

By typing your name at the end of a document can count as a signature.

First Name

Last Name

Today's Date *

MM

DD

YYYY