CH Waiver and Release

Rider or Participant Name*

First NameLast Name

Rider or Participant Email*

example@example.com

Rider or Participant Phone Number

Area CodePhone Number

Today's Date*

Date

Rider or Participant is 18 years old or older*

Yesno

Guardian or Parent Name

First NameLast Name

Guardian or Parent Phone Number

Area CodePhone Number

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Area CodePhone Number

Waiver and Release

I, the named rider or participant above and the undersigned (if under 18 years old, the parent or guardian) request permission to enter into various equine activities with Tessa Nicolet and/or Cohesive Horsemanship.

I know that the temperament and character of equines are unpredictable. I know that there are risks not limited to, but including, the animals biting, kicking, running away, shying with potential to cause harm to the animal in question, myself, my child, other animals, and damage to facilities. I have inspected the premises and I know the risks and dangers involved in such activities, and that
unanticipated and unexpected dangers may arise during such activities, and I assume all risk to my, or my child’s person and/ or property that may be sustained in connection with equine activities.

In consideration of the permission granted to me to enter into equine activities, I hereby, for myself, my heirs, administrators, and assigns; release, remiss, and discharge Tessa Nicolet and/or Cohesive Horsemanship, and the owners, operators, and sponsors of the premises and officials, and all other participants in equine activities of any sort, for injury sustained to my person and/or property
and/or equine, or that of my child during my presence or theirs on the premises and my presence and/or participation in equine activities due to negligence or any other fault.

I represent and certify that my true age is over 18, and if I am under 18 years, I represent and certify that I have the permission of my parents and/or guardians to participate in equine activities, and that they have full knowledge thereof.
I certify that my attendance and participation in equine activities is voluntary.

I understand that under Arizona Law, pursuant to A.R.S. S12-553 an equine activity sponsor or professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities.

I have read and understand the foregoing request and release and hereby hold Tessa Nicolet and/or Cohesive Horsemanship harmless of any injury, paralysis, or death in connection with equine activities.

I further understand that it is Tessa Nicolet’s and Cohesive Horsemanship’s policy for all riders under 18 to wear a protective riding helmet at all times while riding. Riders over the age of 18 understand the risks of riding without a helmet and that wearing a protective riding helmet can prevent injuries. I understand that I can choose to refuse the protection of a helmet and do so
at my own risk.

I have read and agree to the above release and waiver*

I have read and agree to the above waiver

Protective Riding Helmet Waiver

I acknowledge that there are dangers inherent with equine activities including being thrown to the ground. I am assuming this and other hazards upon myself since I wish to ride. I realize I am subject to injury from this activity and that no form of pre-planning can remove all dangers to which I am exposing myself. If I am 18 years old or older I may chose to ride without a protective riding helmet. The helmet could prevent permanent brain damage in the event of an accident. Even considering my own knowledge of the medical statistics relating to horse related injuries I may chose not to ride with a helmet.

Protective Helmet Waiver*

Yes, I am 18 years or older and understand that I can choose to ride with or without a helmet. I understand the above statement and am assuming all associated risks.No, I am under the age of 18 and understand that I must wear a helmet at all times.

Photograph, and Video Waiver

I understand that Tessa Nicolet and/or Cohesive Horsemanship can and will take video and photographs during lessons, clinics, or other events. These can be used as educational, promotional, or other materials including on social media into the future.

Photograph and Video Waiver*

I consent to allow Cohesive Horsemanship and/or Tessa Nicolet to use photographs and videos of my likeness for educational, promotional, and/or other materials.I do not consent to the above

By Signing Below I agree to the above waiver and release*

On touch screens you can use your finger or pointer. Otherwise Click and Hold the cursor to sign

Type in signed Name*

First NameLast Name

I certify that the above is correct and true. I understand by submitting this form I waive my rights as described above.

Cohesive Horsemanship LLC