The Happy Horse, LLC
Riding Instruction Agreement/ Liability Release (initial each section)
AGREEMENT:
I, ______represent that I am over the age of 18 / the parent or legal guardian of: ______. I have had ample time to consider this agreement, and I wish for myself / my child to take horseback riding and horsemanship instruction from Victoria Hicken and or her appointed Instructors. I have been given a copy of the Fee Schedule and Barn Rules; understand them and will follow and review them with my child. (______)
Risks/Informed Consent:
I understand that equine activities / horseback riding is a contact sport. Being in the presence of horses or ponies involvesdangers, hazards, and risks. That these are “inherent”; meaning they are an integral part of participating in an equine activity. That these risks include but are not limited to:
A. Being kicked, bitten, stepped on, pushed, pulled, thrown or otherwise falling from the horse while standing or in motion, or colliding with another horse, object, or rider at any given rate of speed.
B. That horses are live animals and have the potential to react in unpredictable ways to other horses, people, sounds and objects. A horse’s behavior/disposition can change from day to day. There can be variations in terrain and unpredictable ground conditions.
C. That injuries to a rider, persons handling horses on the ground, or spectators, are a common occurrence in equine activities. Those injuries include but are not limited to; sprains, strains, contusions, concussions, lacerations, broken bones, back, neck, and head injuries some of which may be permanent or result in the death of a participant. (______)
By signing this agreement I am stating: I am aware of the previously mentioned risksand I believe the benefits of me/my child participating in equine activities outweigh the risks for injury. (______)
LIABILITY RELEASE
“WARNING UNDER NEW JERSEY LAW, AN EQUESTRIAN AREA OPERATOR IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN EQUINE ANIMAL ACTIVITES RESULTING FROM THE INHERANT RISKS OF EQUINE ANIMAL ACTIVITIES, PURSUANT TO P.L. 1997, C.287 (c.5:15-1 et seq.)
1. No suit shall be instituted by the student or the parents or guardian of a student, jointly or severally, against the property owner, Victoria Hicken, The Happy Horse LLC, Instructors, or volunteers, to recover damages or loss actually or allegedly resultant to the parents of the student or to either of them by reason of an injury or fatality which, while on the premises or off the premises, either for instruction, in connection with instruction, or competition, such students shall sustain.
2. The student or parents of a student of Victoria Hicken and her appointed Instructors, agree to save Victoria Hicken, The Happy Horse LLC, any owner, Instructor, employee, volunteer, harmless against any and all claims, demands, or suits, which shall be brought by anyone not signatory hereto and which shall be predicated upon any such injury or fatality so sustained by a student of Victoria Hicken or her appointed Instructors.This agreement is intended to be as broad and inclusive as the law permits. If any clause, phrase, or word of this agreement is in conflict withstate law, then that single part is void; all other aspects of the agreement remain in force.
3. This combined pledge against suit and promise of indemnification shall be effective immediately and shall automatically terminate if and when Victoria Hicken, The Happy Horse LLC, receives written notice of termination signed by adult student, either or both of the student’s parents. Termination however, shall not affect application of the forgoing previsions, (1) and (2), for any mishap, which shall have previously occurred.
4. The Happy Horse LLC, Victoria Hicken, Instructors, land owners, employees, or volunteers are not responsible for personal property damage, loss, or theft while on or off the premises.
I hereby agree to the foregoing as the: Adult Student/ Parent/ Legal guardian of above-mentioned student (both parents must sign):
______
Adult Student (Signature) Date
______
Father/Legal Guardian (signature) Date Mother/Legal Guardian (signature) Date
The Happy Horse LLC Student Registration
Mail completed form to PO Box 57, AtcoNJ, 08004
______
Name Age Date of Birth ______/______NJ ______Address Town Zip
______/______/______
Home phone Wireless Work Email
CHA Horsemanship Books (Level I, II, III, and IV) are $25.00 each, REQUIRED reading for students, and available online for purchase at CHA website.
Please circle day & time, indicate 1st / 2nd choice. 2017 Semesters(please circle):
Day Time Spring: April 4th –June 10th Summer: June 20th–Aug 26th
Tues 10am, 1130, 1pm, 4pm Fall: Sept 5th – Nov 11th “Year Round” Student Thurs 10am, 1130, 1pm, 4pm Saturday 9:30am, 1030am, 1230pm,
Circle one- registering for: Private / Semiprivate lessons, Equine Explorers, Minis & Me
I would like to ride ____ x per week. Each additional lesson requires an additional tuition, lesson fees are not refundable, and there is a $35.00 returned check fee. There is always at least 1 un-mounted horsemanship lesson per semester. Payment is due upon email confirmation of lesson day and time. See forlesson fees, policies, and other important information.
Has student ridden before? Y N Has student without assistance or coaching: Walked ____ Trot ____ Cantered ____ Jumped ____ Height_____ How many times per week? ______Where? ______When was student’s last lesson? ______
Has student ever fallen while riding? Y N If yes; when? ______Has student ever been injured while riding? Y N
If yes, please explain details of incident and any injury: ______
______
Student’s Height ______Weight ______(this information assists in placing student with appropriate sized horse/pony)
Does Student have an IEP at school? Y N Copy Provided? Y N
Medical Conditions or Allergies: ______
Who may pick up your child? (1)______(2) ______
If your child is injured, attempts will be made to notify you immediately. Basic first aid will be initiated; if further medical attention is needed and we cannot reach you; 911 will be contacted and your child will be promptly taken to the nearest Emergency Department by local EMS. ALL expenses related to patient transport andmedical care provided are your responsibility.
By signing below I am giving Victoria Hicken and or her appointed Instructors/Volunteers consent to obtain emergency medical treatment for my child. I understand and agree that I am responsible for any and all medical expenses incurred.
______
Parent/ Legal Guardian (Print Name) Date
______
Parent/ Legal Guardian (Signature) Date