Riding Instruction Agreement And Liability Release Form
For Individuals
This form must be completed by and for each participant
__________________________________________________________________
Stable Name, hereinafter known as “This Stable”
Address____________________________________________________________
PLEASE READ CAREFULLY BEFORE SIGNING
SERIOUS INJURY MAY RESULT FROM YOU PARTICIPATION IN THIS ACTIVITY.
THIS STABLE DOES NOT GUARANTEE YOUR SAFETY.
A. REGISTRATION OF RIDERS AND AGREEMENT PURPOSE - In consideration of the payment of a fee and the
signing of this agreement, I, the following individual, and the parent or legal guardians thereof if a minor, do herby
voluntarily request and agree to participate in riding instruction as a student at THIS STABLE, and that this student will
either ride his/her own horse, or a school horse provided by THIS STABLE for instructional purpose, today and on all
future dates:
Rider Name Age Weight Horse Riding Experience
(if under 21) Over 240 (Check one which applies)
_____________________________ _______ ___Yes ___Beginner (under 10 hours)
___ No ___Over 10 Hours
Does this rider have a physical or mental health problem which may affect his/her ability to ride a horse?
Yes No
If “yes” describe here:____________________________________________________________________
B. AGREEMENT SCOPE AND TERRITORY AND DEFINITIONS - This agreement shall be legally binding upon me the
registered student and the parents or legal guardians thereof if a minor, my heirs, estate, assigns, including all minor
children, and personal representatives; and it shall be interpreted according to the laws of the state of THIS STABLE’S
physical location. If any clause, phrase or word is in conflict with state law, then that single part is null and void. The
term “HORSE” herein shall refer to all equine species. The term “HORSEBACK RIDING” herein shall refer to riding or
otherwise handling of horses, whether from the ground or mounted. The terms “STUDENT” and/or “RIDER” shall
herein refer to a person who rides a horse mounted or otherwise handles or comes near a horse from the ground. The
terms “I”, “ME”, “MY” shall herein refer to the above registered student rider and the parents or legal guardians thereof
if a minor.
WARNING: Under Pennsylvania Law an equine professional and equine activity sponsor is not
liable for an injury to or death of a participant in equine activities resulting from the inherent
risks of equine activities. “Inherent risks of equine activities.“
Dangers or conditions which are integral part of equine activities. The term includes:
1. The propensity of an equine to behave in a manner which may cause injury, harm or death to
a person on or near it.
2. The unpredictability of an equine’s reaction to sounds, sudden movements, unfamiliar
objects, individuals or other animals.
3. An equine’s reaction to certain natural hazards, such as surface and subsurface ground
conditions.
4. A collision with other equines or objects.
5. An equine’s response to the participant’s manner of handling or controlling it or inability to
handle or control it.
C. ACTIVITY RISK CLASSIFICATION - I UNDERSTAND THAT: Horseback riding is classified as a RUGGED
ADVENTURE RECREATIONAL SPORT ACTIVITY and that there are numerous obvious and non-obvious Inherent risks
always present in such activity despite all safety precautions. According to NEISS (National Electronic Injury
Surveillance Systems of the United States Consumer Products) horse activities rank 64th among the activities of people
relative to injuries that result in the stay at U.S. hospitals. Related injuries can be severe, requiring more hospital days
and resulting in more lasting residual effects than injuries in other activities.
D. NATURE OF THIS STABLE’S SCHOOL HORSES - I UNDERSTAND THAT: THIS STABLE chooses its school horses
for their calm dispositions and sound basic training as is required for use for STUDENT RIDERS, and THIS STABLE
follows a rigid safety program. Yet, no riding horse is a completely safe horse. Horses are 5 to 15 times larger, 20 to 40
times more powerful, and 3 to 4 times faster than a human. If a rider falls from horse to ground it will generally be at a
distance from 3 ½ to 5 ½ feet, and the impact may result in injury to the rider. Horseback riding is the only sport where
one much smaller, weaker predator animal (human) tries to impose its will on and become one unit of movement with,
another much larger, stronger prey animal with a mind of its own (horse) and each has a limited understanding of each
other. If a horse is frightened or provoked it may divert from its training and act according to its natural survival instincts
which may include, but are not limited to: stopping short, changing directions or speed at will; shifting its weight;
bucking, rearing, kicking, biting, or running from danger.
E. RIDER RESPONSIBILITY - I UNDERSTAND THAT: Upon mounting a horse and taking up the reins the rider is in
primary control of the horse. The rider’s safety largely depends upon his/her ability to carry out simple instructions, and
his/her ability to remain balanced and calm aboard the moving animal. I agree that the rider shall be responsible for
his/her own safety.
F. CONDITIONS OF NATURE - I UNDERSTAND THAT: THIS STABLE is NOT responsible for total or partial acts,
occurrences, or elements of nature that scare a horse, case it to fall, or react in some other unsafe way. SOME
EXAMPLES ARE: Thunder, lightening, rain, wind, wild and domestic animals, insects, reptiles, which may walk, run, or
fly near, or bite or sting a horse or person; irregular footing on out-of-door groomed or wild land which is subject to
constant change in conditions according to weather, temperature, and natural and man-made changes in landscape.
G. SADDLE GIRTH/NATURAL LOOSENING - I UNDERSTAND THAT: Saddle girths (saddle fasteners around horse’s
belly) may loosen during ride. If a rider notices that his/her must alert the riding instructor as quickly as possible so
action can be taken to avoid slippage of saddle and a potential to fall from the animal.
H. ACCIDENT/MEDICAL INSURANCE - I AGREE THAT: Should emergency medical treatment be required, I and/or my
own accident/medical insurance company shall pay for all such incurred expenses. My accident or medical insurance
company is _____________________________________________________________and policy number is
____________________________________ .
I. PROTECTIVE HEADGEAR WARNING - I AGREE THAT: I have been fully warned and advised by THIS STABLE that I
should purchase and wear protective headgear (equestrian riding helmet), and do understand that the wearing of such
headgear while mounting, riding, dismounting, and otherwise being around horses, may prevent or reduce severity of
some head injures, and even prevent death from happening as the result of a fall or other occurrence.
J. LIABILITY RELEASE - In consideration of THIS STABLE allowing my participation in the activity, under the terms set
forth herein, I, the rider, and the parent or guardian thereof if a minor, do agree to hold harmless and release THIS
STABLE, its owners, agents, employees, officers, members, premises owners, and affiliated organizations from legal
liability due to THIS STABLE’S ordinary negligence, and I do further agree that except in the event of THIS STABLE’S
gross and willful negligence, I shall bring no claims, demands, actions and causes of action, and/or litigation, against
THIS STABLE and ITS ASSOCIATES as stated above in this clause, for any economic and no economic losses due to
bodily injury, death, property damage, sustained by me and/or my minor child or legal ward in relation to the premises
and operations of THIS STABLE, to include while riding, handling, or otherwise being near horses owned by or in the
care, custody and control of THIS STABLE.
All Riders and Parents or Legal Guardians must sign below after reading this entire document:
Signer Statement Awareness
I/WE THE UNDERSIGNED, HAVE READ AND DO UNDERSTAND AND THE FOREGOING AGREEMENT, WARNINGS,
RELEASE AND ASSUMPTION OR RISK. I/WE FURTHER ATTEST THAT ALL FACTS RELATING TO THE APPLICANT’S
PHYSICAL CONDITION, EXPERIENCE, AND AGE ARE TRUE AND ACCURATE.
______________________________________________________________________________________________
Signature of RIDER(Spouses must sign for themselves) Date Please Print Rider Name Here
______________________________________________________________________________________________
Signature of PARENT, GAURDIAN, AND/OR SPOUSE #1 Date
______________________________________________________________________________________________
Signature of PARENT, GAURDIAN, AND/OR SPOUSE #2 Date
Address:_______________________________________________________________________________________
Home Phone:______________________________________
Mobile Phone:_____________________________________