| GARROD FARMS RIDING STABLES,
REGISTRATION FORM Rider’s Name: ________________________ Phone: _______________ Address: ___________________________________ Zip:____________ Birthdate of Rider___________________ Riding Exp. (circle): 1) None (2) 1 to 5xs (3) 6 to 15xs (4) over 15xs MEDICAL STATEMENT FOR PARTICIPATION IN HORSEMANSHIP ACTIVITIES I hereby certify that (I am) (he/she is) not under the influence of alcohol or drugs or under treatment for any physical infirmity or chronic ailment, or injury of any nature, and that (I have) (he/she has) normal vision or (have, has) never been treated for any of the following: 1) cardiac or pulmonary condition or disease 2) high or low blood pressure 3) nervous disorders 4) fainting spells or convulsions 5) diabetes 6) hard of hearing 7) kidney or related diseases Parent Signature: __________________________Date:__________ or Guardian RELEASE OF INTEREST Pony Trail/Arena Lesson (Parent or Guardian) I, __________________________am aware that Horsemanship activities may be HAZARDOUS ACTIVITIES, and I am VOLUNTARILY participating in these activities with knowledge of the DANGERS involved and HEREBY ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH._______ (Parent or Guardian INITIAL) In addition, I HEREBY INDEMNIFY, RELEASE, AND DISCHARGE Stables, Garrod Trust, and the Trustees, Officers, Directors, Employees, and Agents thereof, and each of them, from all actions, claims, or demands I, my heirs, distributes, Guardians, legal representatives, or assigns now have or may hereafter have for injury or damage resulting from my participation in horsemanship activities. Date: ___________ Parent or Guardian Sign:____________________________________ Important – READ, SIGN, AND DATE COMPLETELY |
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