Release Form

Release Form

Liability Release
As a rider at P5 Equestrian, I acknowledge the risks and potential for risk of a horseback-riding program. However, I feel that the possible benefits to myself are greater than the risk assumed. I hereby, intending to be legally bound, for myself, my heirs, and assigns, executors or administrators, waive and release forever all claims for damages against P5 Equestrian, its board of directors, instructors, therapists, volunteers and/or employees for any and all injuries and/or losses I may sustain while participating in P5 Equestrian activities.

Photo Release
I o DO
o DO NOT
consent to and authorize the use and reproduction by P5 Equestrian of any photographs and any other audio-visual materials taken of me for promotional material, educational activities, exhibitions or for any other use for the benefit of the program.

Authorization for Emergency Medical Treatment
In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on the property of the agency, I authorize P5 Equestrian to secure and retain medical treatment and transportation if needed.

Consent Plan
This authorization includes x-rays, surgery, hospitalization, medication, and any treatment procedure deemed "life saving" by the physician. This provision will only be invoked if the person listed below is unable to consent for treatment.

WARNING

Under Indiana law, an equine professional is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities.

I agree to indemnity and hold harmless P5 Equestrian, their agents and employees from any and all claims, damages, losses, injuries and expenses arising out of or resulting from equine activities in which I participate. I further agree to release and promise and covenant not to sue P5 Equestrian, its agents or employees for any and all actions, causes of action, claims or damages, damages in law or remedies in equity of whatever kind, including the negligence of P5 Equestrian or of myself, my family, or my heirs, arising out of the equine or associated activities in which I participate.

I ________________________ am aware that any activities involving horses are hazardous and I am voluntarily participating in these activities with the knowledge of the danger involved, and hereby agree to accept any and all risks of injury and death.
Date ______________

Signature ________________________________________________________
(Rider/Participant Signature)

Signature _______________________________________________________
(Parent or Guardian Signature if under 18 years of age)

Name ___________________________________________

Phone _________________________
Address __________________________________________

City ___________________ Zip ______________

Emergency contacts:

Name __________________________ Phone ________________ Other ______________ Name ___________________________ Phone ________________ Other ______________
Physician’s Name ______________________________

Preferred Medical Facility ________________________
Health Insurance Company ______________________________ Policy # _______________