RideAbility Participation Form Today’s Date: _________

REGISTRATION:
Name of Student or Volunteer: ______________________________________Date of Birth: __________
Address:_______________________________________________________________________________
_______________________________________________________________________________
Phone: (Home)_________________________________ (Cell)____________________________________
Email:__________________________________________________________________________________
Liability Release
I: _____________________________________(student/volunteer name) would like to participate in the RideAbility
equine activity program. I have been informed of the Minnesota Equine Liability Law, and I acknowledge the risks
and potential for risks of horseback riding and working around horses. However, I feel that the possible benefits to
myself/my son/my daughter/my custodial child 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: RideAbility and - its Board of Directors, Instructors, Therapists, Aides, Horse owners, Volunteers and/or
Employees for any and all injuries and/or losses that I/my son/my daughter/my custodial child may sustain while
participating in RideAbility affiliated activities and special events of any kind.
Signature: _______________________________________________ Date: _________________
If under 18 years of age (or if not responsible for self) a guardian must sign: ________________________________________

Photo and Publicity Release

I consent to and authorize the use and reproduction of any and all photographs and any other audiovisual materials
taken of me/my son/my daughter/my custodial child for promotional printed material, educational activities or for any
other use for the benefit of the RideAbility program.
Signature: _______________________________________________ Date: _________________
If under 18 years of age (or if not responsible for self) a guardian must sign: ________________________________________

Authorization For Emergency Medical Treatment (or NON-CONSENT)

For Registered Student or Volunteer named above: _________________________________________
Preferred Medical Facility: _______________________ Preferred Physician: _______________________
CONSENT PROVISION: In the event emergency medical aid/treatment is required due to illness or injury during the process of
receiving services, or while being on the property of the agency, I authorize RideAbility to secure and retain medical treatment and
transportation if needed, and to release client records upon request to the authorized individual or agency involved in the medical
treatment. This authorization includes x-ray, surgery, hospitalization, medication and any treatment procedure deemed “life
saving” by the physician. This provision will only be invoked if the client (student or volunteer) is unable to communicate.
Signature: _______________________________________________ Date: _________________
If under 18 years of age (or if not responsible for self) a guardian must sign: ________________________________________
OR NON-CONSENT PROVISION: This signature removes all liability from RideAbility in making an emergency medical decision.
Signature: _______________________________________________ Date: _________________
(Student, Volunteer or guardian signature)
RideAbility insurance does not include medical coverage for clients or volunteers.
Please provide personal health insurance information:
Health Insurance Provider: _________________________________Policy Number: __________________

Who should we contact in an emergency: ___________________________Phone number: ___________

Statement of Confidentiality
I understand the importance of respecting all individuals I work with in the RideAbility program. I agree to keep confidential all
knowledge of the medical conditions, emotional conditions, behaviors and opinions of other persons I meet at RideAbility.
Signature: _______________________________________________ Date: _________________
(Student, Volunteer or guardian signature)
RideAbility Training completed (checklist on reverse side)
I have attended RideAbility mandatory training & orientation. I understand the program’s guidelines, rules and expectations.
Signature: _______________________________________________ Date: _________________
(Student, Volunteer or guardian signature)
RideAbility training and orientation checklist:
__ Program history and philosophy (Began in 1997, family centered, fun for all, - SAFETY EMPHASIS)
__ Respect (People first philosophy – and all students, families and volunteers should be respected)
__ Confidentiality (Opinions should stay here … prevent gossip, do not pass-long medical info, sign a statement of confidentiality)
__ Liability Release (MN Equine Liability Law protects volunteers from being liable for injuries, also general liability insurance)
__ Facility (Know where to park, watch your children, use garbage cans, locate: sound system, phone, first aid kit, lost & found)
__ Refreshments (Water jug, soda for donations, bring your own bottled water or soda, volunteer to bring cookies)
__ Absences (Sign-off on white board ahead of time or notify the barn as soon as possible - so we can find backups)
__ Bad Weather (Do not come if you feel unsafe, leave early if you feel you need to – it is your decision!)
__ Volunteer Attire (Required: Sturdy shoes - no sandals, Recommended: bug spray, name tags, tighter clothing)
__ Student Attire (Required: ASTM/SEI certified helmets & long pants, Recommended: sturdy shoes with heel)
Barn requirement: all mounted riders will use ASTM/SEI certified helmets
__ Tack (Well fitted saddle, safety stirrups, halter with reins or bridle, lead rope, cinch safety checked 3 times)
Barn requirement: all mounted riders will use safety stirrups or no stirrups at all
__ Horse handling (Horses tied in the arena, no one is allowed in the arena except for their assigned tasks)
__ Mounting/Dismounting (Mounting ramp procedures, dismount at instructor’s direction, emergency dismount)
__ Teams (Posted on board, work with student before entering the ring, enhancing student accomplishments)
__ Curriculum (Five week basic outline: 1-Evaluation 2-Safety 3-Communication 4-Balance 5-Games & Fun)
__ Class time (Lesson plan flow: mount at mounting ramp, warm-up, horsemanship, games, cool-down, dismount)
__ Side walker training (3 basic holds plus variations, learning about your student, constant feedback to program)
__ Fundraising (1-Giving Letter 2-Nathan Schmidt memorial 3-Barn Dance 4-Raffle 5-RideAThons)
Minnesota Equine Liability Law
Sec. 3 (604A.12) LIVESTOCK ACTIVITIES: IMMUNITY FROM LIABILITY.
Subdivision 1.Definitions.
(a) For purposes of this section, the following terms have the meanings given them.
(b) “Inherent risks of livestock activities” means dangers or conditions that are an integral part of livestock activities,
including: (1) the propensity of livestock to behave in ways that may result in death or injury to persons on or around
them, such as kicking, biting or backing; (2) the unpredictability of livestock’s reaction to things like sound, sudden
movement, unfamiliar objects, persons or other animals; (3) natural hazards such as surface or subsurface conditions; or
(4) collisions with other livestock or objects.
(c) “Livestock” means cattle, sheep, swine, horses, ponies, donkeys, mules, hinnies, goats, buffalo, llamas or poultry.
(d) “Livestock activity” means an activity involving the maintenance or use of livestock, regardless of whether the activity is
open to the general public, provided the activity is not performed for profit. Livestock activity includes: (1) livestock
production; (2) loading, unloading or transporting livestock; (3) livestock shows, fairs, competitions, performances, races,
rodeos or parades; (4) livestock training or teaching activities; (5) boarding, shoeing or grooming livestock; or (6) riding
or inspecting livestock or livestock equipment.
(e) “Livestock activity sponsor” means a person who sponsors, organizes or provides the facilities for a livestock activity that
is open to the general public.
(f) “Participant” means a person who directly and intentionally engages in a livestock activity. “Participant” does not mean a
spectator who is in an authorized area.
Subdivision 2. Immunity from Liability, except as provided in subdivision 3, a nonprofit corporation,
association, or organization, or a person or other entity donating service, livestock, facilities, or
equipment for the use of a nonprofit corporation, association, or organization, is not liable of the death
or an injury to a participant resulting from the inherent risks of livestock activities.
Subdivision 3. Exceptions, Subdivision 2 does not apply if any of the following exist: (1) the person provided livestock for the
participant and failed to make reasonable efforts to determine the ability of the participant to safely engage in the livestock
activity, or to determine the ability of the participant to safely manage the particular livestock based on the participant’s
representations of the participant’s ability; (2) the person provided equipment or tack for the livestock and knew, or should have
known, that it was faulty to the extent that it caused injury or death; (3) the person owns or leases the land upon which a participant
was injured or died because of a man-made dangerous latent condition and failed to use reasonable care to protect the participant;
(4) the person is a livestock activity sponsor and fails to comply with the notice requirement of subdivision 4; or (5) the act of
omission of the person was willful or negligent.
Subdivision 4. Posting Notice, A livestock activity sponsor shall post plainly visible signs at one or more prominent locations in
the premises where the livestock activity takes place that include a warning of the inherent risks of the livestock activity and the
limitation of liability under this section.
I have read and/or been informed of the Minnesota Equine Liability Law.
Signature: _______________________________________________ Date: _________________