Equine Activity Liability Release Form

Equine Activity Liability Release Form
Please review the release text above, complete the participant and activity details, and sign to acknowledge the equine activity liability release.
Participant Information
Participant Full Name
First NameMiddle NameLast Name
Age
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Equine Activity Details
Riding Program or Activity Name
Activity Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Horse Name or Session ID
Rider Experience Level
Other
Riding or Handling Notes
Emergency Contact
Emergency Contact Full Name
First NameMiddle NameLast Name
Relationship to Participant
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Release Acknowledgement and Signature
Equine Activity Liability Release and Risk Disclosure
Signature
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Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: