2024 Linda Clinic Application

Clinic Information: Borrowed Horsemanship with Dr. Linda Parkhurst

Date: October 26 & 27, 2024

Location: Sun State Riding Academy, Clarkdale, AZ Clinic Instructor: Dr. Linda Parkhurst
Name
Address
City State ZIP
Phone Number
Please enter a valid phone number.
Email
example@example.com
Emergency Contact Name
Emergency Contact Number
Please enter a valid phone number.
Request to Use Lesson Horse; please fill only desired horses name below

Yes
Stall requested ($50/day)fill information below

Yes
Name
Breed
Age
Height hands
Experience Level (Beginner, Intermediate, Advanced)
Any Special Needs or Concerns
Riding Information: Experience Level Select

Flatwork and Ground PolesCross Rails- 2"2'3"-2'9"3'+
Goals for the Clinic:
Please Select if you would like to register for the ground work session ($300 for applicants participating in a riding group. $400 for applicants seeking ground session only)

Yes
***Participants in ground session are requested to provide their own ground work flag. We are happy to provide recommendations***

Note: Please email a copy of your horses vaccinations records to sunstateridingacademy@gmail.com
Do you have any allergies or medical condition that might affect your participation in the clinic?
Do you have any questions about the clinic or the equipment that will be provided?
Payment Method, invoice will be sent via Square: Cash, Check, Credit Card

Amount Paid: 50% deposit required at approval of application. An invoice for the deposit will be emailed to the address provided.

A 15% cancellation fee will be withheld from any cancellation refund,deposit non-refundable within 7 days of clinic

BORROWED HORSRMANSHIP LINDA D PARKHURST

EQUINE RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT
Student Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
I hereby enter into this agreement in consideration of my liability and permission to ride OR use any Horse as a participant in a riding and jumping clinic with Clinician and Instructor LINDA D PARKHURST whose address is PO Box 356, Marion, MI 49665.

IMPORTANT NOTICE

BY SIGNING THIS AGREEMENT YOU ARE GIVING UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES IN CASE OF INJURY, DEATH, OR PROPERTY DAMAGE, ARISING OUT OF YOUR RIDING OR USE OF A HORSE AND/OR PARTICIPATION IN EQUINE ACTIVITIES DURING THE RIDING AND JUMPING CLINIC WITH CLINICIAN AND INSTRUCTOR LINDA D PARKHURST, INCLUDING INJURY, DEATH, OR PROPERTY DAMAGE ARISING OUT OF THE NEGLIGENCE OF YOU OR LINDA D PARKHURST.

READ THIS AGREEMENT CAREFULLY BEFORE SIGNING IT. YOUR SIGNATURE INDICATES YOUR UNDERSTANDING OF AND AGREEMENT TO ITS TERMS.

By signing this form, I hereby acknowledge on behalf of myself that I have familiarized myself with the activities that I will be allowed to participate in, and that I do hereby acknowledge and agree that I will participate in these activities without restriction or limitation. I recognize the inherent risks involved in riding and working with horses, including but not limited to:

▪ Bites, kicks, abrasions or contusions from horses.
▪ Being thrown or bucked off by horses.
▪ Scratches or other injury from stalls or enclosures.
▪ Scratches or other injury from grooming tools and other equine equipment and tack. ▪ Allergic reactions to animals, hay, or other allergens.

▪ Tripping in holes or on materials or equipment.
▪ Slipping, falling, or otherwise being injured in the barn, in stalls, or on the grounds, which can be slippery, muddy, wet, or contain or present other hazards.

I hereby specifically forever waive and release LINDA D PARKHURST, her principals and agents from any liability for injury arising out of the inherent risks from riding, working or participating in a stable environment and/or with horses, as well as from the active negligence of LINDA D PARKHURST, her principals and agents.

By signing this agreement I hereby acknowledge that although there may be supervision during my time spent at the riding and jumping clinic with LINDA D PARKHURST, there will not be a nurse on the premises and LINDA D PARKHURST and her principals and agents bear no responsibility for my health or medical care.

I agree to indemnify, save and hold harmless LINDA D PARKHURST and her principals and agents from and against any loss, liability, damage, attorneys’ fees, or costs that they may incur arising out of or in any way connected with either my presence or participation at the riding and jumping clinic or any acts or omissions of LINDA D PARKHURST, principals or agents.

By signing this Agreement, I hereby acknowledge my complete understanding, agreement and consent to my presence and/or participation in the activities at the riding and jumping clinic, without restriction, without liability to LINDA D PARKHURST, her principals or agents, and with full knowledge and understanding of the disclosures, waivers, and releases herein.

If I am present at and participate in the activities of the riding and jumping clinic with LINDA D PARKHURST I do so at my own risk, and I hereby acknowledge and agree that LINDA D PARKHURST and/or any of her principals and agents shall
bear no responsibility or risk associated with injuries that could arise from my presence or participation at the riding and jumping clinic.

I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE:
Name

First NameLast Name
Participants Signature

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I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by signing below, I hereby do consent to the terms and conditions of this Release.
Parent or Guardian Signature

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LINDA D PARKHURST
PO BOX 356 MARION, MI 49665
Should be Empty:

BORROWED HORSRMANSHIP LINDA D PARKHURST