Emergency Contact Form

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Free to Be Equine Center Certified Equine Facilitated Learning Owner - Jamie Schnabel
Participant Name
DOB
Street Address
City State Zip
Phone
Preferred Email
example@example.com
Name
Relationship
Street Address
City State Zip
Home
Work
Cell
Name
Relationship
Street Address
City State Zip
Home
Work
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Free to Be Equine Center Certified Equine Facilitated Learning Owner - Jamie Schnabel

Emergency Medical Preference and
Participant Name
Street Address
City State Zip Code
DOB
Insurance Company
Who Carries Insurance
Insurance Phone
Known Medical Conditions/Allergies
In the event of emergency or injury I
give permission to Jamie Schnabel, Owner - Free to be Equine Center, volunteers, and staff to seek medical treatment at the nearest emergency medical center or contact 911 for (participant)
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Conditions of Nature: Neither Jamie Schnabel nor Free to Be Equine Center are responsible for partial acts, occurrences, or elements of nature that can scare a horse, cause it to fall or react in some unsafe way. Some examples are lightning, thunder, weather, wild or domestic animals, etc.
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Free to Be Equine Center Certified Equine Facilitated Learning Owner - Jamie Schnabel

LIABILITY RELEASE AGREEMENT AND CONSENT TO PARTICIPATE

desire to participate in equine facilitated learning. I acknowledge the risks and potential risks of equine-assisted activities. However, I believe that the potential benefits to myself/my child are greater than the risk assumed.

Ihereby, intending to be legally bound for myself, my heirs and assigns, executors and

administrators, waive and release forever any claims for damages against Jamie Schnabel and Free to Be Equine Center, staff, instructors, Board of Directors, and volunteers, for any and all injuries, losses that I or my child may sustain while participating in equine assisted activities with
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Participant NameSignature 14 above

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