Health Form – Horses for a Change

Health Form

This form is required for all new & returning riders. It must be re-submitted annually or any time the rider's health information changes. PLEASE NOTE: you will be required to upload a copy of the rider's immunization records as part of completing this form. You cannot save and return to this form, so please only begin if you have the rider's immunization records ready to upload.

Step 1 of 2

Enter Your Details to Register for Saddle Club

We'll get back to you to confirm your enrollment and answer any questions.

Rider's Name *

First

Last

Rider's Date of Birth *

Guardian's Name *

First

Last

Email *

Phone Number *

Best Method of Contact *

Email
Phone
Text
Any

(Optional) Message

If you have any questions, special needs, or concerns feel free to type them here

Legal Liability Release

Please read our legal liability release agreement below and sign to continue to payment. A copy of this release will be emailed to you or you can press print now.

I represent that I am an adult signing on my own behalf or on behalf of my minor child, and that I wish to take riding and horsemanship instruction from Horses for a Change, Inc., at Frog Hollow Farm.

I understand that riding horses and working in the stable area has inherent dangers, and that I may be seriously injured, or even killed in a horse related accident. By way of illustration, a horse related accident includes being stepped on, kicked or otherwise struck by a hoof, bitten, or a fall from the horse.

Horses for a Change has represented to me that reasonable care will be used in the selection of horses for me to ride, and in supervising my riding lesson. I understand that Horses for a Change and its employees or agents cannot prevent accidents, and I do not expect them to do so. I have been specifically advised that I can expect a fall from a horse in the natural course of learning to ride. If at any time during a lesson I become fearful to the point that I wish to dismount, I will so advise my instructor.

I hereby specifically release, indemnify and hold Horses for a Change, Inc. and/or its employees, officers or agents harmless from liability for any claims that may arise out of my activities on the premises. I also specifically release, indemnify and hold Frog Hollow Farm and/or its employees, officers or agents harmless from liability for any claims that may arise out of my activities on the premises. In signing this contract, I am binding myself, my survivors, or any other person or entity seeking to assert a claim on my behalf or which arises from an accident occurring at Horses for a Change at Frog Hollow Farm, even if such accident results in permanent disability, injury or death.

End of document, please confirm you agree to the above.

Have you read and accept the Liability Release terms? *

I have read and accept the Liability release terms

Do you agree that your digital signature is legally binding for our Liability Release form? *

I agree to be legally bound by this digital signature for the Liability Release Form

Phone

Emergency Information

Health Information

Tell us about the rider's abilities

Medical Release

Enter Your Details to Register for Saddle Club

Legal Liability Release