Académique Documents
Professionnel Documents
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Box 4928
Spanaway, WA 98387
253-820-3289
www.changingrein.org
2012 Changing Rein Equine Assisted Activities and Therapies. | Hands on Horses Application |
Warning: Under Washington Law, 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.
Participant Application
Date of Application: _______ / _______ / _______
Name (First/Middle/Last):
_______________________________________________________________________________
DOB: ______ / ______ / ______
Age: _________
Gender:
M / F
Address:
____________________________________________________________________________________________
City: __________________________________________________ State: _________________ Zip Code:
______________
Phone: (H)____________________________ (C)____________________________
E-mail:
______________________________________________________________________________________________
PARENTAL CONSENT FOR PARTICIPANTS UNDER THE AGE OF 18:
Parents/Guardians
(First/Middle/Last):___________________________________________________________________
Address: ___________________________________________________________________________________________
City: ________________________________________________ State: ___________________ Zip Code:
______________
Phone: (H)__________________________ (C)____________________________
(W)______________________________
E-mail: _____________________________________________________________________________________________
EMERGENCY CONTACT INFORMATION
Name: ____________________________________ Phone:
____________________________________________________
Name: ____________________________________ Phone:
____________________________________________________
Have you been around horses in the past? YES
NO
2012 Changing Rein Equine Assisted Activities and Therapies. | Hands on Horses Application |
Warning: Under Washington Law, 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.
Health/Fitness:
Height ________ Weight ________
Can you easily lift 30 to 50 pounds over your head?
Do you have allergies to horses, hay or pollens?
YES / NO
YES / NO
Photo Release
Photo Release / Non Consent
For valuable consideration and which is hereby acknowledged, the undersigned herby grants
permission to Changing Rein, LLC to take or have taken still and moving photographs and films,
including television footage, of the following individual:
Name_______________________________________________________ Date of Birth_____/______/__________
(please print)
The undersigned hereby gives consent and authorizes Changing Rein, LLC in its work to use and
reproduce the photographs, films, and footage to circulate and publicize the same by all means,
including and without limit too, the generality of the newspapers, television, media, brochures,
pamphlets, instructional materials, books and clinical materials.
With regard to the foregoing material, no inducement or promises have been made to us/me to
secure our/my signature(s) to this release other than the intention of Changing Rein, LLC to use or
have used such photographs, films, and footage for the primary purpose of promoting and aiding
Changing Rein, LLC and its work.
______ I give my consent for the Photo Release.
______ I do not give my consent for the Photo Release.
Participant Signature ______________________________________________ DATE _____/_____/_____
Parents Signature (if under 18)
_____________________________________________DATE_____/_____/_____
2012 Changing Rein Equine Assisted Activities and Therapies. | Hands on Horses Application |
Warning: Under Washington Law, 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.
2012 Changing Rein Equine Assisted Activities and Therapies. | Hands on Horses Application |
Warning: Under Washington Law, 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.
ACKNOWLEDGEMENTS
a. The undersigned acknowledges that all equestrian activities and events are inherently
dangerous events and that participation as a competitor, student, observer, volunteer or
paid laborer in any of these events exposes the participant to substantial and serious
hazards and risks of property damage, personal injury and/or death.
b. The undersigned acknowledges that grooming, leading, saddling, mounting, observing,
feeding, and any other activity involving horses exposes the actor to substantial and
serious hazards and risks of property damage, personal injury, and/or death.
c. The undersigned further acknowledges that riding horses in the company of other riders
and horses, whether for pleasure or in a structured event, exposes such rider to
substantial and serious hazards and risks of property damage, personal injury, and/or
death.
II.
RELEASE OF LIABILITY
a. The undersigned agrees to release David and Sandra Boe, Changing Rein LLC, its
members, agents and employees from any and all claims, demands and liabilities
resulting from personal injury, property damage, and/or death arising from the
undersigneds participation in any equestrian event, equine activity, or personal equine
endeavor held in any equine facility that may be designated, currently designated as
David and Sandra Boe, Changing Rein, LLC 6204 288 th St E Graham WA 98338. This
release includes claims, demands and liabilities that are known or unknown, foreseen or
unforeseen, future or contingent, and includes all claims, demands, and liabilities arising
out of negligence by Changing Rein LLC, its members, agents, and employees.
b. The undersigned further agrees to release David and Sandra Boe, Changing Rein LLC, its
members, agents, and employees from any and all claims, demands, and liabilities by
the undersigned for indemnities and contributions arising from property damage,
personal injury, and/or death to a third party.
III.
ASSUMPTION OF RISK
a. The undersigned, having acknowledged the inherent danger associated with
participation in equestrian riding events and equine activities, whether as a competitor,
student, observer, volunteer or paid laborer, hereby voluntarily, knowingly, and expressly
assumes the inherent risks and hazards described herein.
b. The undersigned, having acknowledged the inherent danger associated with riding a
horse in the company of other riders and horses, hereby voluntarily, knowingly, and
expressly assumes the risks and hazards described herein.
c. The undersigned, having acknowledged the inherent danger associated with grooming,
leading, saddling, mounting, observing, feeding and any other activity involving horses,
hereby voluntarily, knowingly, and expressly assumes the risks and hazards described
2012 Changing Rein Equine Assisted Activities and Therapies. | Hands on Horses Application |
Warning: Under Washington Law, 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.
herein.
2012 Changing Rein Equine Assisted Activities and Therapies. | Hands on Horses Application |
Warning: Under Washington Law, 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.
IV.
SEVERABILITY
a. In the event that any provision of this release and assumption of risk is found to be
invalid, unenforceable, or voidable, the remaining provisions shall remain in full force and
effect as if this agreement had been executed without the invalid provision.
V.
INDEMNIFICATION
a. The undersigned agrees to indemnify and save and hold David and Sandra Boe,
Changing Rein LLC its members, agents, and employees, harmless from any and all
claims, demands, and liabilities for any and all property damage, personal injury, and/or
death asserted by a third party that was occasioned by the undersigneds participation in
any equestrian event on the designated equine facility.
VI.
GOVERNING LAW
a. The undersigned agrees that this agreement shall be subject to the laws of the State of
Washington and that any dispute regarding this agreement shall be subject to the
jurisdiction and venue of the State of Washington Superior Court in and for Pierce
County.
VII.
___________________________
____________________________________________
___________________________
_____________________________________________
Print Name
Signature
Address
___________________________
Signature of Parent or Guardian
____________________________________________
Address
___________________________
_____________________________________________
Print Name
2012 Changing Rein Equine Assisted Activities and Therapies. | Hands on Horses Application |
Warning: Under Washington Law, 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.