Rattle Run Farms Riding Lesson Registration Form 2026

Rattle Run Farms Riding Lesson Registration Form

2026
RIDER INFORMATION

Please fill out all information below in its entirety, or the form will not let you continue. When submitting this form, you will be put on a list to be scheduled according to availability, experience, and age. Due to limited availability, scheduling is not guaranteed.
RETURNING RIDERNEW Rider, We had our farm visit alreadyNEW Rider, We need to schedule our mandatory farm visit
Rider's Name:*

First NameLast Name
Age:*
FemaleMale
Height:*
Weight:*
200 lb Weight Limit
Email:*
example@example.com
Primary Contact Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PARENT/GUARDIAN CONTACT INFORMATION
Father:

First NameLast Name
Father Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Mother:

First NameLast Name
Mother Phone:
Please enter a valid phone number.Format: (000) 000-0000.
In Case Of Emergency Contact #1:*

First NameLast Name
Emergency Contact #1:*
Please enter a valid phone number.Format: (000) 000-0000.

RIDER'S CONSENT FOR EMERGENCY MEDICAL TREATMENT
RIDER'S NAME:*

First NameLast Name
DATE OF BIRTH:*

MonthDayYear
Date
FemaleMale
PHYSICIAN'S NAME:*

First NameLast Name
PHYSICIAN'S PHONE NUMBER:*
Please enter a valid phone number.Format: (000) 000-0000.
PREFERRED MEDICAL FACILITY:*
INSURANCE CARRIER:*
POLICY NUMBER:*
PLEASE LIST ANY ALLERGIES, MEDICATIONS, OR OTHER MEDICAL ISSUES WE NEED TO BE AWARE OF.*
Person Authorized to give TEMPORARY assistance of care in the ABSENCE of Parent/Guardian:*

First NameLast Name
Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
RELATIONSHIP TO RIDER:*
In case of medical emergency, the undersigned authorizes Rattle Run Farms, LLC to provide such medical assistance as they determine to be necessary. If the rider named above is younger than 18 years, the undersigned authorizes Rattle Run Farms, LLC, acting through the adult on its staff who has actual care, control, and possession of the child to consent to medical, dental, and surgical treatment of the child when the undersigned cannot be contacted. The undersigned represents to Rattle Run Farms, LLC that he or she is the child’s parent and either (i) is not divorced from the other parent, or (ii) is divorced from the other parent, but has been authorized by a written court order to give consent to medical care, dental care and surgical treatment of the child. The undersigned will indemnify and hold Rattle Run Farms LLC, its officers, members, employees, and agents harmless if he or she is not empowered by law to give this consent.

The undersigned authorizes any licensed physician and/or medical facility to provide any medical/surgical care and/or hospitalization for the child, including anesthetic, which they determine necessary or advisable, pending receipt of a special consent form from the undersigned.

No person can be accepted for riding instruction until this form has been completed by the parent/parents or guardian. If the person is of legal age (18), he or she may complete the form, if he or she is legally competent to do so. Riding instruction will be under strict supervision, and although every effort will be made to avoid any accident, NO LIABILITY can be accepted by any organization concerned with this instruction, including Rattle Run Farms, LLC in the event of any accident that may occur.
YES, I agree

PHOTO RELEASE

Riders may be photographed or videotaped andtheir names published for non-profit use in various ways: newsletter articles,community newspaper articles, videos, television broadcasts, lesson pictures,and Liberty Riders, Inc. web pages. Ifyou do not want your child to have his/her name, picture or video taken please make your request in writing.
LIABILITY RELEASE

The above rider would like to participate in the Rattle Run Farms, LLC program. I acknowledge the risks and potential for risks of horseback riding. However, I feel that the possible benefits to myself/ my son/ my daughter/ my ward are greater than the risk assumed. I hereby, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against Rattle Run Farms, LLC, its Board of Directors, Instructors, Therapists, Aides, Volunteers and/or Employees for any and all injuries and/or losses I/ my son/ my daughter/ my ward may sustain while participating at Rattle Run Farms, LLC.
MICHIGAN EQUINE ACTIVITY LIABILITY ACT

Under the Michigan Equine Activity Liability Act, an equine professional is not liable for an injury to or death of a participant in an equine activity resulting from an inherent risk of the equine activity.
YES, I agree

RIDING LESSON SCHEDULING INFORMATION

This page is designed to help Rattle Run Farms schedule lessons according to availability, experience and ages. Please select the available days and times that work best for you. This does NOT guarantee that lesson time is available.
FIRST CHOICE DAY:*
FIRST CHOICE TIME:*
SECOND CHOICE DAY:*
SECOND CHOICE TIME:*
THIRD CHOICE DAY:*
THIRD CHOICE TIME:*
Session #1 - January 5th - February 9th (6wks = $300) *Closing Date: Dec. 22nd*Session #2 - February 16th - March 23rd (6wks = $300) *Closing Date: Feb. 2nd*Session #3 - April 6th - May 11th (6wks = $300) *Closing Date: March 23rd*Session #4 - May 18th - June 22nd (6wks = $300) *Closing Date: May 4th*Session #5 - June 29th - July 27th (5wks = $250) *Closing Date: June 15th*Session #6 - August 3rd - August 31st (5wks = $250) *Closing Date: July 20th*Session #7 - September 14th - October 12th (5wks = $250) *Closing Date: Aug. 24th*Session #8 - October 19th - November 16th (5wks = $250) *Closing Date: Oct. 5th*Session #9 - November 23rd - December 17th (4wks = $200 *Closing Date: Nov. 9th*
Have you ever taken riding lessons before? If Yes, please explain your experience. Please include any comments regarding scheduling. *

RIDER CHECKLIST

BASIC PROGRAM RULES AND REQUIREMENTS
Riding Lesson Fees are due in FULL at first lesson.CASH or CHECK ONLY$10 Late fee applied if not paid in full at first lesson.Horse Riding Helmets (ASTM-SEI Approved) are mandatoryLong pants and boots with a heel are required. No shorts, tennis shoes or sandals.If your rider is late, the lesson will not be held.If a rider cannot attend a lesson - that lesson will not be rescheduled or refunded. Please notify RRF if your rider cannot attend.If Rattle Run Farms has to cancel a lesson, we will credit/reschedule/refund our riders.No personal dogs allowed on the farm.
IF YOU HAVE ANY QUESTIONS, PLEASE EMAIL US AT: rattlerunfarms@gmail.com

BY SIGNING BELOW YOU ARE ACKNOWLEDGING, ACCEPTING, AND AGREEING TO ALL PREVIOUS PAGES RELEASES, LIABILITIES, TERMS, CONDITIONS, AND THE ABOVE PROGRAM RULES AND REQUIREMENTS.
Print Name of Parent/Guardian (If under 18 yrs):*

First NameLast Name
Signature of Parent/Guardian (If under 18 yrs)*
Today's Date:*

MonthDayYear
Date
Should be Empty:

Rattle Run Farms Riding Lesson Registration Form

RIDER INFORMATION

PARENT/GUARDIAN CONTACT INFORMATION

RIDER'S CONSENT FOR EMERGENCY MEDICAL TREATMENT

PHOTO RELEASE

LIABILITY RELEASE

MICHIGAN EQUINE ACTIVITY LIABILITY ACT

RIDING LESSON SCHEDULING INFORMATION

RIDER CHECKLIST