Roots & Reins Academy Registration Form

Child's Full Name

First NameLast Name

Child's date of birth

MonthDayYear

Parent/Guardian Full Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Emergency Contact

First NameLast Name

Emergency Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

Child’s T-shirt Size

What grade level will your child be entering for the upcoming school year?

Please provide the name, address, and phone number of your child’s most recent and previous schools.

Does your child have any medical conditions? Please list any medical conditions, allergies, or health concerns we should be aware of.

Does your child currently have an Individualized Education Program (IEP) or a Section 504 Plan?

If yes, please attach a current copy of the plan.

Do you plan on using scholarship funds, If so which scholarship do you receive?

Has your child previously received any educational support services?

If yes, please check all that apply:

Please provide any additional information regarding these services:

Will your child be staying for aftercare from 3:30 to 5:30 pm?

I understand that participation may involve inherent risks including outdoor activity, physical movement, and interaction with tools or environments.

I understand that horses and other animals may react unpredictably to sounds, movements, unfamiliar persons, weather, or other animals, and may bite, kick, buck, rear, step on, push, or otherwise behave in ways that could result in injury

I understand and voluntarily accept the inherent risks for my child associated with participation in equine and farm-related activities, including but not limited to grooming, feeding, leading, groundwork, riding (if applicable), barn chores, handling tack/equipment, walking on uneven surfaces, interacting with farm animals, and participating in educational or therapeutic activities

I release Relentless Equestrian Stables, its staff, and affiliates from all liability for injuries, damages, or losses related to participation.

I authorize emergency medical care if needed and accept responsibility for associated costs.

In case of minor cuts and accidents, first aid trained staff will perform first aid on your child and you would be notified immediately.

In case of a serious emergency, we will call 911 for an ambulance and you will be notified immediately.

An incident report will be written and provided if there is any accident or dispute.

I agree that participants will follow safety rules and respectful behavior, and understand unsafe behavior may result in removal without refund.

I understand that fees may be non-refundable unless otherwise stated

I understand that programs may involve travel or multiple locations and accept associated risks.

I grant permission for Relentless Equestrian Stables to use photos and videos of my child for promotional purposes.

Under Florida law, an equine activity sponsor or equine professional is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities.

“Inherent risks of equine activities” include, but are not limited to:

The propensity of an equine to behave in ways that may result in injury, harm, or death to persons around them;
The unpredictability of an equine’s reaction to sounds, sudden movement, unfamiliar objects, persons, or other animals;
Hazards such as surface and subsurface conditions, including uneven terrain;
Collisions with other equines, animals, people, or objects; and
The potential for a participant to act negligently in a manner that contributes to injury, including failing to maintain control or follow instructions.
I, the undersigned parent/legal guardian, acknowledge that I have read and understand this Florida Equine Activity Liability Notice and understand that my child’s participation in equine-related activities is voluntary and involves inherent risks.

Parent/Guardian Initials

Signature

Today's Date

Date

Roots & Reins Academy

Waiver Acknowledgements

Media Consent

FLORIDA EQUINE ACTIVITY LIABILITY NOTICE