Child’s name:_____________________________________
Parent’s name:____________________________________
Does this child have any medical or behavior conditions that Country View
staff need to be aware of?
YES NO
If yes, please describe: ___________________________________________
____________________________________________________________
Phone and address to contact in case of emergency: ________________________
_____________________________________________________________
Alternative emergency contact person and phone: __________________________
______________________________________________________________
I understand that Wisconsin state statute 895.481 provides a civil liability exemption for people involved in equine activities and states that: A PERSON WHO IS ENGAGED FOR COMPENSATION IN THE RENTAL OF EQUINES OR EQUINE EQUIPMENT OR TACK OR IN THE INSTRUCTION OF A PERSON IN THE RIDING OR DRIVING OF AN EQUINE OR IN BEING A PASSENGER UPON AN EQUINE IS NOT LIABLE FOR THE INJURY OR DEATH OF A PERSON INVOLVED IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OR EQUINE ACTIVITIES, AS DEFINED IN SECTION 895.481 (1)(E) OF THE WISCONSIN STATE STATUTES.
I agree to follow Country View Equestrian Center rules and obey any instructions given to me by Country View staff.
Child’s signature:_________________________________________
Parent/Guardian Signature:__________________________________
CVEC staff Signature:______________________________________