Release and waiver of liability horse riding is a dangerous activity

EASTSIDE HORSE RIDING ACADEMY

“D” Pavilion

Centennial Parklands Equestrian Centre

Paddington

02 9360 7521

RELEASE AND WAIVER OF LIABILITY

HORSE RIDING IS A DANGEROUS ACTIVITY

1. 
   I understand and acknowledge that horse riding is a dangerous activity and that horses can act in a sudden and unpredictable (changeable) way, especially if frightened or hurt.
   

I understand that serious INJURY OR DEATH may result from horse riding activities including this ride. I agree that I RIDE at MY OWN RISK. I am aware that there is to be no cantering on the track.

2. 
   The escort rider or instructor has the authority to demand that any rider bringing danger to the horse, him/herself, or any other riders will dismount immediately. Any refusal will result in the CANCELLATION of my riding fee and my immediate removal from my horse NO MATTER what may occur. In the event of any accident that may occur I shall not hold Eastside Horse Riding Academy or its agents responsible.
   

3. 
   If I ride unescorted it is at MY OWN RISK at all times and Eastside Horse Riding Academy or it agents will not be held liable for any accident/injuries.
   

4. 
   I agree that I will wear a helmet and that must not remove it until I am off the horse.
   

5. 
   I agree not to drink alcohol or take drugs prohibited by law before or during this ride.
   

RIDERS PARTICULARS

Please state any injuries or illnesses, which could affect the Rider’s ability, safety or health.

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NAME (of rider)………………………………………………………….DATE………………………
ADDRESS………………………………………………………PHONE…………….
EMAIL ADDRESS If you would like any notices or offers……………………………………………...
Ridden 0-10 times Ridden 11-20 times Ridden 21-50 times Ridden 51-100 times Ridden 101+ times

Effect of this Document

I understand that my signature to this document constitutes a complete and unconditional release of all liability of the proprietors of Eastside Horse Riding Academy and its employees and agents to the greatest extent allowed by law in the event of me and /or the children under my care suffer injury or death.
Signature of Rider………………………………. Date…………….. Horse Ridden………………….
Duty of Proprietors of Eastside Horse Riding Academy

The proprietors of Eastside Horse Riding Academy will exercise due care and skill in providing each rider with a suitable horse and will conduct the ride keeping in mind the welfare and safety of the rider. (Section 74 Trade Practices Act

Signature of Proprietor………………………………. Date……………..

EMERGENCY CONTACT DETAILS:
Please fill in the following details for the next of kin of the rider. These details will only be used in an emergency when we are unable to contact anyone on the above details.
Please ensure these details are completed thoroughly.
Riders name:…………………………………………………………….
Name of next of kin:………………………………………...…………...
Relationship:……………………………………………………………..
Address:……………………………………..…………………………...

Home:……………………
Work:………………….…
Mob:……………....………
Allergies:

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Eastside Horse Riding Academy

D Pavilion, Centennial Parklands Equestrian Centre

Lang Road, Paddington

Ph: 9360 - 7521 Fax: 9360 - 7521

www.eastsideriding.com.au

SCHOOL HOLIDAY CAMP

Please tick the camp dates you wish to attend.

Tuesday________ – Thursday ____________2015 [ ]

SCHOOL HOLIDAY CAMP

ONE SET OF FORMS PER RIDER
Name:…………………………………………………….… Age:……….……
Address:……………………………………..………………………………….

Home:…………………… Work:…………………… Mob:……………………
EXPERIENCE (please circle): Beg/Walk/Trot/Canter/Jump
PAYMENT DETAILS (please tick):

(Note: All 3 day camp bookings will not be accepted without a minimum $100.00 deposit. All 1 day camp bookings will not be accepted without full payment.)

Payment amount:

One day camp booking (non refundable) ($200.00) [ ]

3 day camp booking - deposit only (non refundable) ($100.00) [ ]

Full 3 day amount (non refundable) ($560.00) [ ]

Method of payment:

Cash [ ]

Cheque [ ]

Credit card [ ]

CREDIT CARD PAYMENTS ONLY
Amount due: $___________
Type of card (please circle): VISA/MasterCard/Bankcard
Card number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Expiry date: __/__

Signature: _______________________