Reining Strength Volunteer & Staff Renewal

Contact Information

First Name

Last Name

Birthdate

01/01/2000

Personal Email

Preferred Method of Contact

If there has been any change in information, please complete the following:

Street Address

City

State

Zip Code

Cell Phone

Home Phone

Work Phone

Preferred Phone

Employer

Title

Days & Times Available

Availability Details

Health Status

Allergies

Emergency Contact Information

#1 Name

Home Phone

Cell Phone

Work Phone

Liability Release

the undersigned adult as client, or parent or guardian of

, a minor, would like to participate at Reining Strength Therapeutic Horsemanship.

I acknowledge the risks and potential for risks of equine activities. I understand that I/my son/daughter/ward, will be working with and around horses, as well as, riding horses at Reining Strength Therapeutic Horsemanship. However, I feel that the possible benefits to myself/son/daughter/ward are greater than the risk assumed. I, the undersigned client and/or parent or guardian, hereby, intending to be legally bound, for myself, my heirs, and assigns, executors or administrator, waive and forever release, acquit, discharge and hold harmless all claims for damages against Reining Strength, its board of directors, trustees agents, instructors, therapists, employees, representatives, volunteers, owners of property on which Reining Strength Therapeutic Horsemanship operates, successors or assigns on account of any personal injuries and/or personal damages known or unknown, or in any way growing out of, the acts of Reining Strength Therapeutic Horsemanship, its board of directors, trustees, agents, instructors, therapists, employees, representatives, volunteers, owners of the property on which Reining Strength Therapeutic Horsemanship operates, successors or assigns.

By entering my name below I understand that under TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), A FARM ANIMAL PROFESSIONAL OR FARM OWNER OR LESSEE IS NOT LIABLE FOR
AN INJURY TO OR THE DEATH OF A PARTICIPANT IN FARM ANIMAL ACTIVITIES, INCLUDING AN EMPLOYEE OR INDEPENDENT CONTRACTOR, RESULTING FROM THE INHERENT RISKS OF FARM ANIMAL ACTIVITIES.

Date

Photo Release

I consent to and authorizeI do NOT consent to

The use and reproduction by Reining Strength Therapeutic Horsemanship of any and all photographs and any other audio/visual materials taken of me or my family member for promotional material, educational activities, exhibitions, or for any other use for the benefit of the program or PATH Int’l.

By entering my name below I agree the photo release statement above.

Date

Contact Information