Lesson Application Release Form

Lesson Waiver of Liability Release Form

* Indicates required field

Rider Name *

First

Last

Date of Birth (dd/mm/yy *

Address Line 1 *

Address Line 2 *

City *

Province *

Postal Code *

Phone Number *

Email *

Alternative Phone Number *

Parent Name (if rider under 18) *

First

Last

Rider Experience *

What was your rider's last colour level recieved? *

Emergency Contact *

First

Last

Emergency Contact Phone Number *

Please describe any medical conditions requiring special precautions. *

Photo Release Statement: I Hereby consent to allowing TJ Stables to use any photographs and/or video tapes for public relations purposes. *

I Accept

WAIVER OF LIABILITY: The undersigned each hereby acknowledges that he/she is at least eighteen years of age and in good health and that Terry Jenkins and TJ Stables and their employees are in no way responsible or liable for any injuries or property damage sustained by the undersigned, however caused, while on the premises or utilizing the facilities, nor are the owners of the property itself in any way responsible or liable for such injury or damage. I hereby release Terry Jenkins, TJ Stables and their employees and the property owners from any and all liabilities, past, present, or future. I understand that there is no warranty as to the fitness or condition of the horses and equipment on the premises and notwithstanding the foregoing waiver, I agree to report any accident or seemingly dangerous condition on the premises immediately learning of same and before leaving the premises, regardless of how insignificant it may seem. I acknowledge having read and foregoing that I am remaining on the premises at my own risk. *

I Accept

Today's Date *

Parent's Name *

First

Last

Submit