Release Form and Informations

Release Form and Contact Information

Fleet Equestrian Center, LLC and If Wishes Were Horses, Inc
Participant 1

First NameLast Name
Date of Birth

MonthDayYear
Date
Participant 2

First NameLast Name
Date of Birth

MonthDayYear
Date
Participant 3

First NameLast Name
Date of Birth

MonthDayYear
Date
Parent/Guardian Name 1

First NameLast Name
Parent/Guardian Name 2

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best Phone For Parent 1
Please enter a valid phone number.
Best Phone For Parent 2
Please enter a valid phone number.
I prefer to be contacted about cancellations by

TextPhone Call
Emergency Contact (In case of emergency, who do you want us to call?)

First NameLast Name
Emergency Contact Number
Please enter a valid phone number.
Other important information:
*Riders, please be aware that our horses are indispensable when it comes to the livelihood of Fleet Equestrian Center, LLC; therefore for their safety, there is a 200 lb WEIGHT LIMIT for all riders.

Lesson Participant Terms and Conditions *Lesson spots must be attended on a regular bases. Anyone missing more than 2 classes in a row, for any reason besides medical or planned travel, will be considered for replacement. Missed Lessons must be paid in full, if you do not wish to give up the spot. *Absences- please give at least (three) hours’ notice of any pre-known absence in writing (text, note, email). * A $10 fee applies for any (one) absence that is not notified within (Three) hour advance, and/or not due to medical/emergency absence. Any prepaid money expires after 6 months of not being used. *Weather cancellations are given 1 hour or more before scheduled classes. Please be aware: We reserve the right to refuse service to anyone, for any reason. Persons exhibiting disruptive or inappropriate behavior will be asked to leave the premises/program. *Persons who cannot fill a consistent lesson spot may call in for available lesson spots, per time, instead of holding a spot.

“UNDER SOUTH CAROLINA LAW, AN EQUINE ACTIVITY SPONSOR OR EQUINE PROFESSIONAL IS NOT LIABLE FOR THE INJURY TO OR THE DEATH OF A PARTICIPANT IN AN EQUINE ACTIVITY RESULTING FROM THE INHERENT RISK OF EQUINE ACTIVITY, PURSUANT TO ARTICLE 7, CHAPTER 9 OF TITLE 47, CODE OF LAWS OF SOUTH CAROLINA.” *Safety is our desire for all riders/observers/participants, but accidents cannot always be prevented due to the inherent nature of this activity. *Persons entering upon the property assume all risks inherent to the nature of this activity.

.
I release and hold harmless Fleet Equestrian Center, LLC, If Wishes Were Horses, Inc, all board members, associates and instructors: Margaret and Bryan Fleet & any Instructors, Assistant or Junior Instructors from any injuries, accidents, and death that may occur due to the nature of this activity.

I am fully responsible for all visitors and family members that I bring onto the premises. Any injury to visiting persons or of property is waived on the same terms as the conditions set above.
I/My Children/Child, have/has permission to participate in the aforementioned activities:

I have read & understand the Equine Liability Immunity Act, as it relates to equine participants and observers.I have read the above terms and conditions of this release and agree to themI am being made aware that there is a lesson information and rule PDF on the website under the "forms tab" that I can review for more in-depth information and policies.
Do you (the participant)/your child (the participant) have any of the following: Regular Lesson Enrollment - Conditions & Diagnoses that qualify rider for Recreational Therapeutic Riding Program

NoneAnxietyPhobia, FearDepressionPanick AttackSelective MutismOCDPTSDASD high functioning/mildADHDASD high functioning/mild with ADHDScoliosis/other Musc. SkeletalChrone's, Celiac, IBS, other GIRespiratory - Asthma, OtherSelf Image Issues - Anorexia, Bulimia, Obesity, OtherEmotional Issues -Self esteem, confidence, isolation, self-harm,Greif and Loss - Recent and ProlongedArthritis - Juvenile, RheumatoidMood Disorders - mild to moderateDyslexiaSensory - Auditory, VisualOther
Anything specific you want to say about these conditions and goals you would like to reach with horseback riding?
Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
For School and Activity Group Enrollment. Does your child have any of the following: Conditions & Diagnoses that qualify rider for Disability Inclusive Therapeutic Riding Program. Most Require Md Rx** and evaluation to ride (This is not a complete list but may be used in the event that the accompanying parent forgets to fill out the class paperwork - the other paperwork must be filled out with class or activity group). + Requires waivers for specific condition

Seizures**+Down's Syndrome**+Chromosomal Abnormalities**Cardiac Disfunction**Brain Injuries, Dysfunction**Sensory or Tactile ImpairmentCerebral Palsey**Muscle Tone conditions**Physical Conditions/ Impairment**ASD moderate to profound**Mood Disorders- Moderate to Profound**Sensory/Tactile Can't wear helmet (waiver needed)+Physical DisabilityIntellectual DisabilityNoneOther
Should be Empty:

Release Form and Contact Information