Trademark Stables, LLC
2437 Olive Chapel Road Apex, North Carolina 27502 Application / Waiver of Riding Privileges
Rider's Name: _________________________ DOB:____________ Age:______ Sex:______
Address: __________________________________________________________
Telephone: _______________ (Home) ________________ (Work) _______________ (Cell)
Email: ________________________________________________
Parent/Guardian: ___________________________________________________________
Previous Riding Experience: Years: ________ Level of Competition: ____________________
Own a Horse / Pony: ___ (Y/N) Lease a Horse/ Pony: ___(Y/N)
If so, how long? ____ If so, how long? ____
Describe Experience: _______________________________________________________
________________________________________________________________________
Please list and describe any physical limitations / conditions which might limit or affect your
participation in horse riding activities. Please give full details including but not limited to;
Asthma, Back Problems, Diabetes, and Migraines:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Primary Physician: _________________________Phone Number:____________________
Health Insurance: Insurance information is required of all participants and evidence thereof
must be provided before a person is permitted riding privileges or enrolled in a riding program.
Insurance Company: ________________________________________________________
Address: ______________________________Telephone Number: ___________________
Name of PolicyHolder: ______________________________________________________
Group #: ______________________________ Policy #: ____________________________
Signature of Particpant: _____________________________________________________
Signature of Parent/Guardian: _________________________________________________
ACKNOWLEDGMENT OF RISKS, ACCEPTANCE OF
RESPONSIBILTY, AND WAIVER OF CLAIMS
I recognize that there is a significant element of risk involved in horseback riding and the handling of horses. I state that I am fully capable of participating in such activities and I certify that I have no physical conditions, which might interfere with my capability to participate in horseback riding. Knowing the inherent risks, damages, and rigors involved in horseback riding, I assume responsibility for myself / my child for bodily injury, death, loss of personal property and all expenses thereof, which may occur as a result of my / my child's participation in the handling of horses and/or horseback riding and waive any and all claims which may result therefrom.
I recognize that the risk of serious injury is increased by not wearing certified helmet while horseback riding. I agree to wear a certified protective helmet all times and understand that ALL students are required to wear Certified helmets any time mounted on a horse.
I have read, understand, and agree to the terms and conditions stated herein. I acknowledge that this agreement shall be effective and binding upon me / my child during the entire period of my participation in handling of horses and / or taking of horseback riding lessons upon the premises of Trademark Stables, LLC. / Jennifer Lafforthun shall not be liable and under direction of Trademark Stables on off-site locations.
Signature of participant or parent / guardian if under 18.
This is the _________ day of ________________________, 20___.
WARNING! Under North Carolina 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 exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina Statutes.
S 99E-2 Liability Except as provided in subsection (b) of this section, an equine activity sponsor, an equines professional, or any other person engaged in equine activity, including a corporation or partnership, shall not be liable for an injury to or the death of a participant resulting from inherent risks of equine activities and, except as provided in subsection (b) of this section, no participant or participant's representative shall maintain action against or recover am equine activity sponsor, an equine professional, or any other person engaged in an equine activity for injury, loss, damage, or death of the participant resulting exclusively from any of the inherent risks of equine activities.
___________________________________________________ Participant
___________________________________________________ Parent / Guardian
| 
