Miller’s Equestrian Center and Sanctuary
Formerly known as The Educational Equine Haven
PO Box 14254
San Luis Obispo, CA 93406
805-235-3834

Release and Hold Harmless Agreement

Miller’s Equestrian Center and Sanctuary

Whereas, the Undersigned acknowledges the inherent risks involved in riding and working around horses, which risks include bodily injury from using, riding or being in close proximity to horses, among other risks, and further, that both horse and rider can be injured in normal use or in competition and schooling;

In Consideration, therefore, for the privilege of riding and/or working, around horses at Hidden Springs Ranch under Miller’s Equestrian Center and Sanctuary the Undersigned does hereby agree to hold harmless and indemnify Michele Miller AKA Michele Downs, Torie Dye, Brenna McGovern, Amanda Shere, and Hidden Springs Ranch and further release them form any liability or responsibility for accident, damage, injury, or illness to the Undersigned or any horse owned by the Undersigned or to any family member or spectator accompanying the Undersigned on the premises of Hidden Springs Ranch and Miller’s Equestrian Center and Sanctuary AKA Downs Riding School.

Date                                                     

Instructor:______________________________

Type of Class:  □ Mom & Me     □ Parks & Rec.   □ Private    □ Group    □ Camp     □ Show

Riders Name ____________________________

Parents Name __________________________________

Phone #_________________________________

Cell #___________________________________

E-mail __________________________________

Parent or Guardian Signature __________________________

Payment Agreement

Payment shall be made in advance for each month.  Cancellation notification should be given 24 hours in advance otherwise you will be charged the full price of your missed lesson.  All cancellations should be made up within a month of canceling otherwise you will be charged for your cancelled lesson.  There are many available lessons to attend to make up your lesson just contact Michele for the times.  All checks are to be made out to Michele Miller and placed in the black box in the tack room.  Monthly billing is available.  See Price list for full descriptions of prices.

Payment Program □ Group($30)    □ Group 3 Month Program    □ 1/2 hr Private($35)    □ Private($45)   

I have read and understand the above.

Parent or Guardian Signature ____________________________

Riders Address & Zip                                                                               

Emergency Contact Numbers:

Parents Names & Numbers                                                   

Other contact Names & Numbers                                        

Riders Birthday                                                  Age                                  

Other Information                                                                                   

In Case of Illness or Emergency

In case of illness or emergency, permission is hereby granted for the treatment of same by first aid and/or paramedical personnel.  I also grant the use of an anesthetic if deemed necessary by a treating physician or surgeon.  I understand that, in the case of a minor, an attempt will be made to contact a parent or legal guardian before the minor is referred to a physician, paramedic, surgeon, and/or hospital for treatment.

I am allergic to the following medications or drugs:___________________

Date__________________

_________________________________________________________

Signature of rider or, in the case of a minor, parent or legal guardian