Riderís Name:_______________________________________ Age (if under 18) ___
The rider agrees to fully indemnify and hold harmless the riding instructor, Pirouette Farm, Inc., any of its officers, employees, invitees, operators of its premises,
or other members of such activities from and against all claims, penalties, actions, losses costs, damages, injuries, liabilities and obligations, including but not
limited to, any and all attorney fees, of whatever kind and nature which may be incurred by or asserted against any of them as results of any act, failure to act,
or neglect by the rider or student rider.
Limitations of Liability
The parties executing this form, for themselves, their heirs, executors, administrators, successors, and assigns, release and forever discharge the riding instructor,
Pirouette Farm, Inc. and any of its officers, employees, invitees, operators of its premises, or other members of such activities from any and all damages resulting
from or due in whole or part to any acts, failure to act, negligence or neglect of other riders, the riding instructor, Pirouette Farm, Inc. any of its officers,
owners, employees, invitees, operators of its premises, or other members of the facilities.
WARNING: Under law, an equine activity sponsor is not liable for an injury to, or the death of, a participant in equine activities
resulting from the inherent risks of equine activities that are obvious and necessary, pursuant to 12 V.S.A. section 1039. (Vermont
Statutes Title 12, Chapter 27, Subchapter 2, section 1039)Additional Warning: Safety Helmets with chinstrap are to be worn at all
times when mounted on a horse.
Executed in , this__________________day of ______________________, 20____.
Rider/Student Signature Pirouette Farm, Inc. Representative
Name and Telephone # of Emergency Contact
If Rider/Student is under 18 years:
Guardian Name, Signature, Address, and Telephone #
Pirouette Farm, Inc. Riding Waiver
Please print this page and mail in