Please
return this form with a non-refundable deposit of $100
By June 20th. The remaining $150 is due June 21st
Spring Valley Registration and waiver
Child’s name__________________________________age____________
Parents/Guardian_____________________________________________
Address____________________________________________________
___________________________________________________________
E-mail______________________________________________________
Phone(s)____________________________________________________
Emergency Contacts___________________________________________
__________________________________________________________
Known allergies or other medical conditions or information
___________________________________________________________
___________________________________________________________
Release and Hold Harmless Agreement
The undersigned assumes the unavoidable risks inherent in all horse-related
Activities, including but not limited to bodily injury and physical harm to horse
rider, and spectator.
In consideration, therefore, for the privilege of riding, breeding, working around
Horses or visiting
the premises of Spring Valley Hunters
located at
indemnify
Rise Jones, employees of
and/or partners of said operation, and further release them from any liability or
responsibility for accident, damage, injury, or illness to the undersigned or to
any horse owned by the Undersigned or to any family member or spectator
accompanying the Undersigned on the premises.
Warning:
Under
is not liable for an injury to or death of a participant in equine
activities
resulting from the inherent risks of equine activities pursuant to the
equine activities liability protection act.
____________________________________________________________
Parent/Guardian signature Date