6407 E. Cactus Road, Scottsdale, AZ 480.948.

1069 RELEASE FORM for:

85254

I hereby acknowledge that I accept complete responsibility during all riding lessons with TWIN ACRES SCHOOL OF RIDING or IRA SCHULMAN on the property located at 6407 E. Cactus Road and also while riding on my own at TWIN ACRES SCHOOL OF RIDING or the IRA SCHULMAN property at 6407 E. Cactus Road. I further acknowledge that I will not hold TWIN ACRES SCHOOL OF RIDING, ITS OWNERS, HORSE OWNERS, STAFF, MEMBERS, SERVANTS or AGENTS liable or responsible for my injury while participating in activities at TWIN ACRES SCHOOL OF RIDING at the IRA SCHULMAN property at 6407 E. Cactus Road. I RIDE AT MY OWN RISK but agree to take all necessary precautions to prevent any and all unnecessary accidents. Furthermore, I will report any problems with result from my lessons. I hereby release TWIN ACRES SCHOOL OF RIDING, ITS OWNERS, HORSE OWNERS, STAFF, MEMBERS, SERVANTS or AGENTS and the IRA SCHULMAN property at 6407 E. Cactus Road ITS OWNERS, HORSE OWNERS, STAFF, MEMBERS, SERVANTS or AGENTS from all liability for personal injury or property damage, or injury to my own horse or the horse which I have been assigned to for lessons, and assume all risk of accident and/or injury arising from approaching, handling, riding or maintaining a horse upon the premises of TWIN ACRES SCHOOL OF RIDING at the IRA SCHULMAN property at 6407 E. Cactus Road arising from participation in any riding activity, horse show, rodeo event, trail ride, racing, hay ride, polo game or any other activities or events. This holds harmless shall apply to any horse or horses being used by me or the care and use of horses of TWIN ACRES SCHOOL OF RIDING, ITS OWNERS, HORSE OWNERS, STAFF, MEMBERS, SERVANTS or AGENTS and the IRA SCHULMAN property at 6407 E. Cactus Road ITS OWNERS, HORSE OWNERS, STAFF, MEMBERS, SERVANTS or AGENTS. The undersigned further agrees that should TWIN ACRES SCHOOL OF RIDING, ITS OWNERS, HORSE OWNERS, STAFF, MEMBERS, SERVANTS or AGENTS or IRA SCHULMAN at 6407 E. Cactus Road ITS OWNERS, HORSE OWNERS, STAFF, MEMBERS, SERVANTS or AGENTS find it necessary to trailer my horse or other horses for me, that TWIN ACRES SCHOOL OF RIDING, ITS OWNERS, HORSE OWNERS, STAFF, MEMBERS, SERVANTS or AGENTS or IRA SCHULMAN at 6407 E. Cactus Road ITS OWNERS, HORSE OWNERS, STAFF, MEMBERS, SERVANTS or AGENTS shall not be responsible for any accidents arising from transporting (trailering) loading or unloading or any other pertinent action involving my horse. Furthermore, the undersigned assumes full responsibility and liability for the conduct and safety of any and all minors brought to the premise. Also, proper care and conduct while on or using any horse for lessons will be exercised at all times and no horse will be put away wet, and shall be groomed and walked dry before being put into a stall. THE UNDERSIGNED has advised TWIN ACRES SCHOOL OF RIDING or the IRA SCHULMAN property at 6407 E. Cactus Road of any/all known medical problems that are pre-existing and could be the cause of emergency medical attention. Any known allergies, injuries, diseases or medical problems that could endanger the life or health of either the rider or the horse, should be listed on the bottom of this release form. The undersigned shall pay for all costs and attorney fees arising from any suit or legal action which is brought by the undersigned.

PARENT OR GUARDIAN (Please print)

SIGNATURE of Parent or Guardian

ADDRESS

DATE

CITY, STATE, ZIP

STUDENT NAME

TELEPHONE #

STUDENT SIGNATURE

EMAIL In case of emergency NOTIFY: ANY MEDICAL CONDITIONS:

STUDENTS BIRTHDAY PHONE #