I give permission for all those who work with me/the rider to be informed of any restrictions of conditions that may impact my/the rider's well-being while participating in any of our programs.
In the event of a an emergency where medical aid/treatment is required due to illness or injury during the process of receiving services or while being on the property of Horses for a Change or Frog Hollow Farm, I authorize Horses for a Change to secure and retain medical treatment and transportation if needed and the release of my/the rider's records upon request to the authorized individual or agency involved in the medical emergency.
In the event that the emergency contact(s) cannot be reached, I also authorize x-ray's, surgery, hospitalization, medication and any treatment or procedure deemed "life-saving" by the physician.
All information will be kept confidential.
For health and safety reasons, please don't bring your dog(s) to the barn. Please call the barn with any questions or if you are interested in riding with us: 845-384-6424
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.
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