Application / Waiver of Riding Privileges 

Release Form

Release Form

Rider's Name
Rider's Name
First
Last
Address
Address
City
State/Province
Zip/Postal
ft. in.
Riding Experience?
Own or Lease a Horse / Pony
Please list and describe any physical limitations / conditions which might limit or affect your participation in horse riding activities. Please give full details including but not limited to; Asthma, Back Problems, Diabetes, and Migraines:
ACKNOWLEDGMENT OF RISKS, ACCEPTANCE OF RESPONSIBILTY, AND WAIVER OF CLAIMS I recognize that there is a significant element of risk involved in horseback riding and the handling of horses. I state that I am fully capable of participating in such activities and I certify that I have no physical conditions, which might interfere with my capability to participate in horseback riding. Knowing the inherent risks, damages, and rigors involved in horseback riding, I assume responsibility for myself / my child for bodily injury, death, loss of personal property and all expenses thereof, which may occur as a result of my / my child's participation in the handling of horses and/or horseback riding and waive any and all claims which may result therefrom. I recognize that the risk of serious injury is increased by not wearing certified helmet while horseback riding. I agree to wear a certified protective helmet all times and understand that ALL students are required to wear Certified helmets any time mounted on a horse. I have read, understand, and agree to the terms and conditions stated herein. I acknowledge that this agreement shall be effective and binding upon me / my child during the entire period of my participation in handling of horses and / or taking of horseback riding lessons upon the premises of Memory Lane Farm, LLC. / Jessica Owen-Smith  shall not be liable and under direction of Memory Lane Farm, LLC on off-site locations.

WARNING! An equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities.

Payment accepted: Venmo @Jessic-Owen-Smith, Zelle, Cash, Check, Credit card (least preferred)

Cancelation: 24-Hour cancellation policy. Please dress appropriately for weather. Classes will still be held in rain or snow.

In the event of heavy rain or snow, classes will still be held. We will conduct horsemanship lessons in the barn.