Dian Betsy Lundell- Burkett/ Sarabande Academy/
6405 W Ina Rd, Tucson, AZ (520) 907-3965
Release/Hold Harmless Agreement and Covenant Not to Sue
NOTICE: THIS IS A LEGALLY BINDING AGREEMENT
By signing this agreement, you waive your right to bring court action to recover compensation or obtain remedy for any injury to yourself or
for your death however cause arising out of your use of the facilities known as Sarabande Academy of Riding or River Bend Ranch, now or any
time in the future caused by the negligence, whether or not contemplated by A.R.S. 12-****, of the owners, officers, agents, or employees of
Sarabande Academy or River Bend Ranch.
I hereby acknowledge and agree that activities involving horses have inherent risks and can result in permanent injury or death. I have full
knowledge of the nature and extent of all risks associated with activities involving horses and use of the facilities at Sarabande Academy and
have had any questions about the same explained to me including, but not limited to: 1) all manner of injury or death resulting from the care,
handling, and riding of horse, and 2) all manner of injury or death resulting from faulty equipment or defects to the property, whether obvious
or hidden, such as holes, slippery surfaces, protruding or sharp objects, machinery, and the like. I further acknowledge that the aforementioned
list of risks does not include all possible risks associated with horse activities and the listed risks in no way limit the extent or reach of this
waiver and covenant not to sue.
I herby acknowledge that I accept complete responsibility during all riding lessons with Dian Betsy Lundell- Burkett and/or employees or
agents of Sarabande Academy of Riding on or off Ranch property and also while riding on my own at or through Sarabande Academy of
Riding on or off property. I will assume all risk of accident and injury to arising from approaching, handling, riding, or maintaining a horse
upon the premises of Sarabande Academy of Riding ranch arising from participation in any riding activity, horse show, rodeo event, trail ride,
racing, hay-ride, or any other activities or events.
I further acknowledge that I will not hold Sarabande Academy of Riding, Dian Betsy Lundel- Burkett, staff, members, servants, agents, or
horse owners liable or responsible for any injury incurred while participating in any activities at Sarabande Academy of Riding at the property.
I, the undersigned, on behalf of myself, my heirs, representatives, executors, administrators and assigns, herby release Sarabande Academy of
Riding, Dian Betsy Lundell- burkett, staff members, servants, agents, and/or horse owners from all liability for personal injury or property
damage, or injury to my own horse or the horse that I have been assigned to for lessons AND WAIVE MY SUBSTANTIAL RIGHTS TO
ASSERT any causes of action, claims or demands of any nature whatsoever, including, but not limited to a claim of NEGLIGENCE that I, my
heirs, representatives, executors, administrators and assigns may now or in the future have against Sarabande Academy of Riding, Dian Betsy
Lundell, staff, members, servants, agents, or horse owners on account of personal injury, death, or property damage, arising out of or in any
way relating to my performance of activities through/at Sarabande Academy of Riding, whether said activities are supervised or unsupervised,
however damage is caused.
This hold harmless/waiver shall apply in regard to any horse or horses being used or in the care and use of Dian Betsy Lundell_ Burkett, staff
members, servants, agents, horse owners, and shall apply to any equipment affiliated with Dian Betsy Lundell/ Sarabande Academy of Riding.
The undersigned further assumes full responsibility and liability for the conduct and safety of any and all minors brought by them to the
premises. Furthermore, proper care and conduct while on or using any horses for lessons will be exercised at all times and no horse will be
mishandled.
_________________________________
Parent or Guardian (please print)
__________________________________
Signature of Parent or Guardian (or Student)
_________________________________
Student Name (please print)
__________________
Date
STUDENT INFORMATION FORM (please print neatly!)
Personal Info:
Student Name _________________________________
DOB _____________________
Allergies or physical limitations _______________________________________________
_________________________________________________________________________
Prior Horsemanship Experience: _______________________________________________
__________________________________________________________________________
Contact Info:
_______________________________________________________________________________________
Home Address
Home Phone _____________________________ Email ________________________________________
Parent/Guardian’s Name _______________________________ Cell Phone # ______________________
Parent/Guardian’s Name ______________________________
Emergency Contact: ________________________
Primary # ___________________________________
Cell Phone # ______________________
Relation to student ______________________
Secondary # ____________________________