Equine Specialties

Equestrian Facility






                                    First                                                    Last


Phone Number:___________________/________________________

                                                Day                                         Evening



             Street/Box           City                    Province           Postal Code


Riding Experience - Select all that apply


Western____ Roping____ English____ Reining____ Trail____

Cutting____ Pleasure____ Dressage____ Working_________

Team Penning____ Jumping____ Barrels____ Halter_______    




Years of Experience_____________________


Please select the option that describes your skills as a rider:


Beginner_________                               Intermediate_________                      Advanced________








Acknowledgment of Risk and Release of Liability


Name   _________________________     Date of birth ____________

Address________________________     City ____________________

Province_________________     Postal Code____________________


Every person Must Read and understand this form before any equine activity.


To Equine Specialties, and their trainers, employees, volunteers, business operators, and site property owners, (all of them collectively called the Host)






Initial each item below, after reading and understanding the items.


____1) Understand there are inherent Dangers, Hazards, and Risks. (Collectively called the risks) associated with equine activities and injuries resulting from these “risks” are a common occurrence.

____2) I acknowledge that the inherent risks of the equine activities means those dangerous conditions which are an integral parts of equine activities, include but not limited to: The propensity of an equine to behave in ways that might result in injury, harm, or death to person, on or around them and to potentially collide with, bite or kick other animals, people, or objects;

            The unpredictability of the equines reaction to such things as sounds, sudden movement, tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface objects;

            The potential for other participant(s) to act in any negligent manner that might contribute to injury to themselves or others, such as failing to act within their ability or to maintain control over an equine.                                                                                                     

­­____3) I freely accept and fully assume all responsibility for inherit risks and possibilities of personal injury, death, property damage or loss resulting from my participation in equine activities.

____4) I acknowledge that it remains my sole responsibility to act in such a manner as to be responsible for my own safety and to participate within my own limits.

____5) In addition to consideration given for my participation in the equine activities, I and my heirs, executors, administrators, and assigns, (collectively called my “Legal representatives”) agree:

            To waive all claims, that might have against the “Host” and.

To release the “Host” from any and all liability for any loss, damages, injury, or expense that I or my legal representatives might suffer as a result of my participation due to any cause whatsoever, including any negligence on the “Host”, and to hold harmless, and indemnify the host from any and all liability for operty damage or personal injury to any third party, which may result from my participation in equine activities.


Before signing this form. I read it (as indicated by my initials) and I state I understand it, I know that signing this form, waives certain legal rights I or my “ legal representatives” may have against the host.


Signed date: __________________________________________


Print name of Witness_________________________________ 


Signature of Participant________________________________


Signature of Witness__________________________________