Green Acres Stable Boarder and Student Contact and Emergency Information
A must have contact and emergency information for everybody on the farm and a signed liability form- please fill out and sign below
Email address
Relationship with Green Acres Stable
Minor First Name
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Minor Last Name
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Minor Date of Birth
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First Name
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Last Name
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Date of Birth
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Phone number
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Phone number (2)
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Address:
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Allergies:
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Medical Information
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Emergency contact info
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Emergency contact info (2)
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Doctor and phone number
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Agreement for Release and waiver of liability for Green Acres Stable, Madbury, NH
I request permission to participate in horseback riding and/or lessons at Green Acres Stables. Located at 174 Drew Rd. Madbury, NH 03823
I fully understand that horseback riding in all aspects (which include riding over fences, other obstacles, and steep and rough terrain), are very dangerous activities, I wish to participate in these activities knowing they are dangerous. I accept and assume all the risks of injury (including death) to myself or my property.
In exchange for being permitted to participate in these activities, for myself, my children, my heirs, guardians and legal representatives, I release and agree not to make or bring any claim of any kind against Dawn Dascomb or its officers, directors, members, instructors, employees, or guests of any landowners, landholders, or other persons making property available for Dawn Dascomb, for any injury (including death), to me or any damage to my property whether from anyone’s negligence or not, or any other cause, arising out of my participation in these dangerous horseback riding or related activities; I also agree if anyone makes claim because of any injury to myself (including death), or for any damage to my property, I will keep all those release by this agreement free of any damages or costs because of those claims.

NH EQUINE WARNING LAW: Attention: Under New Hampshire Law, a participant in equine activities assumes the risk of any injury, harm, damage, or death and any legal responsibility that may occur to participant resulting from the inherent risks associated with equine activities. Pursuant to R.S.A. 508:19, equine professionals are not liable for damage resulting from the inherent risks of equine activities.

Signature- type full name for release -parent or guardian if under 18
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