Birthday Party Release Form for Healing Pastures at C Horse Ranch
www.healingpastures-chorseranch.org
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Rider Name (First & Last Name) *
Nickname or preferred name
Rider Age *
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Rider Height & Weight *
Birthday Party Host Name *
Gender or Preferred Pronouns
Parent Name (First & Last Name) *
Will parent be at the party as well? *
Parent Email *
Parent Phone number *
Address *
City, State, Zip *
Riding Experience *
For your student's safety, do they have any medical conditions that would affect their ability to ride or follow directions? *
Proper clothing should be worn for your protection: 

-Long Pants (no shorts or capris)
-Long or Short sleeved shirt (no tank tops, tube tops, spaghetti straps, sleeveless, etc.) 
-Bring a water bottle if warm outside
-Sturdy Hard Soled shoes or Boots, will be provided by the ranch if needed
-Helmets will be provided by the stables, but you can bring your own if you have one.
 *
Required
I, the undersigned, volunteer, or parent or guardian of a minor, for and in consideration of the agreement of Healing Pastures at C Horse Ranch to provide riding instruction to said minor, do/does forever release, acquit, discharge and hold harmless Healing Pastures at C Horse Ranch, its agents, employees, representatives, successors, and assigns, for all manner of claims, demands, and damages of every kind and nature, where to which the undersigned or said minor may now, or in the future, have against Healing Pastures at C Horse Ranch, it’s agents, employees, representatives, successors, or assigns on account of personal injuries, physical or mental condition, known or unknown, to the person of said minor and the treatment thereof, as a result of, or in any way growing out of the acts of Healing Pastures at C Horse Ranch, its agents, employees, representatives, successors, or assigns including but not limited to negligence or gross negligence, in executing the services above described and/or incidental thereto.    

PLEASE read the ‘Assumption of Risk Agreement' located below, inside the Barn and on our website and know that when you or your child are here at Healing Pastures at C Horse Ranch you are riding at your own risk. And I acknowledge that these warnings and suggestions pertain only to some of the risks and risk reduction suggestions for horse activities and to assume others are not stated in this form. I/WE are not relying on Healing Pastures at C Horse Ranch (THE PROVIDER) to list all possible risks for me. By dating this agreement, it is acting as my signature.
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In the event that I cannot be reached PLEASE contact:

(Please include first and last name, telephone number, and relationship)
 *
In the event medical aid/treatment is required due to illness or injury during the process of receiving services or while being on the property of Healing Pastures at C Ranch, I authorize Healing Pastures at C Horse Ranch or the agent for the program to:

-Secure and retain medical treatment and transportation if necessary
-Release client records upon request to the authorized individual or agent involved in the medical emergency treatment

This authorization includes X-Ray, surgery, hospitalization, medication and any treatment procedure deemed "lifesaving" by the physician. This provision will only be invoked if the person above is unable to be reached
 *
Required
I, the undersigned, voluntter, the parent, or guardian of a minor, agree to let Healing Pastures at C Horse Ranch use any and all photos of myself or child for promotional purposes. *
Required
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