Riding Lessons Registration Form

Name _______________________________________ Today's Date __________________ Address ________________________________ City _________________ Zip _________ Home Phone _______________ Email _______________________ Date of Birth_________ Age _____ Weight ______ Other contact number__________________________________ If student, name of school _____________________________________________________ Parent/Guardian Name and Address (if applicable) ___________________________________ __________________________________________________________________________ How did you learn about Moonraker Quarter Horses? _________________________________ Please describe your experience with horses: ________________________________________ __________________________________________________________________________ What are your goals for taking these riding lessons? ___________________________________ ___________________________________________________________________________ (Example: to learn more about horses - I know nothing!, to better my riding position, to learn a different type of riding style.. English/Western etc.) Please check the type of lessons you want to register for: ___ Beginner    ___ Beginner/Intermediate    ___ Intermediate   ___ Advanced Beginner - In this class series you will learn how to halter, lead, groom and tack a horse, knot tying and safety awareness. While mounted you will learn how to walk and trot independently in an arena and steer a horse through an obstacle course. Balance is a crucial component learned at this stage. Beginner/Intermediate - Our classes advance the skills such as stirrup and girth adjustments, balance, steering/control, coordination, problem solving and organization. Skills at the trot such as 2-point position, circles, serpentines and figure 8's become a focus. A student may spend as many sessions as necessary at this level to become competent before going on to the intermediate level. Intermediate - This class series will add skills such as bending exercises for the horse, lateral movements, different lengths of stride and pace, and beginning collection. This will be coordinated with learning the basics of a specified direction/discipline the student is interested in. Advanced - Our advanced class series is for refinement and polish. This course series will be collaboration between the rider and the instructor to determine the specific content. All classes have a set curriculum. Riders will need to show proficiency in order to advance to the next class. Due to the importance of understanding and practicing the basics, many individuals may need to repeat a level until they are comfortable with the skills they have acquired. Liability Release As a rider at Moonraker Quarter Horses, I acknowledge the risks and potential for risk of a horseback-riding program. However, I feel that the possible benefits to me are greater than the risks assumed. I hereby, intending to be legally bound, for myself, my heirs, and assigns, executors or administrators, waive and release forever all claims for damages against Moonraker Quarter Horses, its instructors, volunteers and/or employees for any and all injuries and/or losses I may sustain while participating in riding lessons at Moonraker Quarter Horses. Date _____________ Signature__________________________________________ (Parent or Guardian Signature if under 18 years of age) Print name of rider: ______________________________________ Authorization for Emergency Medical Treatment In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on the property of Moonraker, I authorize Moonraker Quarter Horses to secure and retain medical treatment and transportation if needed. Name _____________________________________ Phone ______________________ Address ________________________________ City _______________ Zip ________ Emergency contacts: Name _______________________________ Phone ______________ Other _________ Name _______________________________ Phone ______________ Other _________ Physician's Name ____________________________________________ Preferred Medical Facility _____________________________________ Health Insurance Company _____________________________ Policy # _____________ Consent Plan This authorization includes x-rays, surgery, hospitalization, medication, and any treatment procedure deemed "life-saving" by the physician. This provision will only be invoked if the person listed below is unable to consent for treatment. Date ____________ Consent signature _________________________________________ (Parent or Guardian Signature if under 18 years of age) Print Name _____________________________________ Phone ____________________ Address _____________________________ City ________________ Zip ___________ Non-Consent Plan I do not give my consent for emergency medical treatment/aid in the case of illness or injury during the process of receiving services or while being on the property of Moonraker. In the event of emergency treatment/aid is required, I wish the following procedure to take place: __________________________________________________________________________ __________________________________________________________________________ Date _________ Non-Consent Signature _________________________________________ (Parent or Guardian Signature if under 18 years of age) Print Name _____________________________________ Phone ____________________ Address _____________________________ City ________________ Zip ___________ Colorado Equine Liability Statute Under Colorado Law, an equine professional is not liable for an injury or the death of a participant in equine activities resulting from the inherent risks of equine activities pursuant to section 13-21-119, Colorado revised statutes. I agree to indemnity and hold harmless Moonraker Quarter Horses, their agents and employees from any and all claims, damages, losses, injuries and expenses arising out of or resulting from equine activities in which I participate. I further agree to release and promise and covenant not to sue Moonraker Quarter Horses, its agents or employees for any and all actions, causes of action, claims or damages, damages in law or remedies in equity of whatever kind, including the negligence of Moonraker Quarter Horses or of myself, my family, or my heirs, arising out of the equine or associated activities in which I participate. I ________________________ am aware that any activities involving horses are hazardous and I am voluntarily participating in these activities with the knowledge of the danger involved, and hereby agree to accept any and all risks of injury and death. Date __________ Signature _________________________________________________ (Rider/Participant Signature) Signature ______________________________________________ (Parent or Guardian Signature if under 18 years of age)