Liability Waiver
Name of Equine Owner
First Name
Last Name
Horse Name
Name
Address of Barn
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
E-mail
example@example.com
Cellular Number
I ______________ permission to REST to take and use videos/photos of the session for social media
give
DO NOT give
REST Liability Waiver - Terms and Conditions
I understand that equine bodywork therapy and services offered by Rowan's Equine Sports Therapy are never a replacement for proper veterinary care. I understand that the Rowan's Equine Sports Therapy practitioner will not diagnose conditions, attempt any skeletal adjustments or prescribe medications, nutraceuticals or supplements for my horse. I understand that any suggested therapies, training adjustments, tack changes or feeding recommendations should be cleared by my veterinarian. If my horse is currently being seen by a veterinarian, I have cleared this work with the attending veterinarian to ensure body work is at this time is appropriate for the horse. I acknowledge that muscle releases may result in underlying muscle mechanisms being exposed that were previously masked through compensatory movements. If you are leasing this horse then written approval from the horses owner will be needed, please contact Rowan for this form. Cancellation Policy - 24 hours notice is required for cancellations, if less than 24 hours notice is given and the appointment is not rebooked, a $50 non-refundable fee will be billed. Multiple cancellations or last minute rebookings may result in termination of services. Late Fees- If full payment is not made after 30 days from the appointment date, late fees will apply. Beginning at $10 and $5 each day there after. Failure to make a payment after 60 days will result in termination of services unless prepayments are discussed and received. Adherence to protocols - Rowan's Equine Sports Therapy takes great pride in their work and in making the world a better place for the horses. Rowan puts a lot of time and energy into continuing education and research to further her knowledge base and provide the best services possible for her clients and she expects the same level of attention and commitment from them. Failure to follow/adhere to any given recommendations (that you have cleared by your veterinarian when applicable) may result in termination of services, this will be determined by Rowan .If you are receiving any push back from your trainer/coach for ridden or in-hand exercises given, please refer them to contact Rowan via email at rowansequinesportstherapy@gmail.com. By signing this document I acknowledge that I have read and understand it and all of its provisions and I am signing voluntarily. I do hereby waive and release Rowan's Equine Sports Therapy from all liability, past, present and future for ALL of my equine participants.
Signature
Signing Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: