B. Equestrian Riding Programs Inc. Release & Hold Harmless Agreement
Whereas, the UNDERSIGNED acknowledges & assumes the inherent & unavoidable risks & dangers involved in
riding and working around horses, which risks include but not limited to bodily injury, physical harm & damage to
horse, rider, spectators, vehicles & trailers from using, riding or being in close proximity to horses.
IN CONSIDERATION, therefore, for the privilege of riding, taking riding lessons, driving &/or working around horses
during riding lessons with B. Equestrian riding programs, located at the stables in which the lessons or activities take
place; I acknowledge the risks and potential risks of a horseback riding program, including risk of bodily injury or
death resulting from kicks and bites, falling off horses or horse falling on rider, being dragged by a foot caught by a
foot caught in the stirrups, being thrown by horse, equipment failure or collision with horses or vehicles or other
inanimate objects. However I feel the possible benefits to my family or the child I care for are greater than the risk
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 B. Equestrian Riding Programs Inc., its board of directors,
instructors, therapists, and volunteers for any and all injuries and/ or losses I may sustain as a result of use of B.
Equestrian Riding Programs Inc. property, equipment, or the facilities at which the lesson or programs take place.
WARINING: Under Georgia 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 from the inherent risks of equine activities, pursuant to Chapter 12
of Title 4 of the Official Code of Georgia Annotated.
Date __________ (this is the date on which the release was filled out; this agreement is not only for today but for all
visits or riding lessons/activities programs or clinics in the future with in conjunction with B. Equestrian riding
programs.)
Print name below of the adult rider or participant (&/or Legal guardian of below named minors.
______________________________________ ______ Date of Birth: _____________________
Full Home Address: _____________________________________________________________
Phone Number:____________________ Emergency Name & Number: ____________________
Emergency Contact & Phone: ______________________________Relation: _______________
Signature: _____________________________________________________________________
Print name of persons under 18 for whom (you named above) are taking full responsibility as a Parent or Guardian
and agree to supervise at all times while visiting during riding programs/lessons. I HAVE READ THE RELEASES AND
GIVE EMERGENCY MEDICAL, PHOTO AND LIABILITY CONSENT AS INDICATED ABOVE: The people listed below
are bound by the above Release and Hold Harmless agreement also.
______________________________________ Date of Birth: _____________________
______________________________________ Date of Birth: _____________________
Photo Release: (check one) (___ I consent to and authorize), (___I do not consent to nor authorize) the use and
reproduction by B. Equestrian Riding Programs of any and all photographs and any other audio visual materials
taken of me for promotional material, educational activities, exhibitions or for any other use for the benefit of the
programs.
Medical Release: In case of emergency (check one) (___I consent to and authorize), (___I do not consent to nor
authorize) B. Equestrian Riding Programs to secure medical treatment including x-ray, anesthetic, medical or surgical
diagnosis or treatment and hospital service rendered under the general or specific instructions of any physician or
hospital. The undersigned hereby agrees to pay all fees and expenses of doctors, hospitals, ambulances and other
medical expenses reasonably and necessarily included.
Payment Method: Cash ____Check ____Credit Card____(See below)
Intro lessons are cash only
Lesson Start Date: _________________
Per Lesson Amount: ______________
Amount Due this Date
After your initial payment by check or cash, all remaining payments will be automatically withdrawn from your credit
card. Students will be invoiced the first of the month for the following month’s tuition and will be charged on the 25th
of the month. Example: you will receive an invoice on June 5th for July Tuition and that amount will be automatically
withdrawn from your credit card on the 25th of June to pay for July Tuition. I agree to provide a written letter to
Tiffany Watkins giving a 30-day notice to be withdrawn from the program. Failure to provide a 30-day notice forfeits
all monies paid. A $30 fee will be charged for all late payments and returned checks and rejected credit cards.
Monthly Method of Payment: (circle one) Master Card Visa
Card No. ___________________________ Expiration Date: _______________
Print Name on Card ___________________________ Signature ________________________________
Card Billing Address if other than home address: ____________________________________________
I authorize B. Equestrian Riding Programs to withdraw the monthly tuition due from above account.
Date: _________________ Card Holder signature: _________________________________
I have read the information above, the Payment Policy and the Riders Release, which I have signed, and agree to
abide by the policies for lesson students, clinic participants, or educational programs participants with Tiffany Bliss
Watkins and B. Equestrian Riding Programs and participating barns.
Sign Here: _____________________________________ Date: ____________________
Signature of student (or Parent/Guardian if student is under 18 years old)
IF YOU ARE UNDER 18 YEARS OF AGE, YOUR PARENT OR GUARDIAN MUST SIGN THIS FORM BEFORE YOU
RIDER OR WORK AROUND HORSES.
MAIL TO: 1313 Carriage Parc Dr. Chattanooga, TN 37421 or email to bequine@hotmail.com if on site please hand
directly to instructor.