We can no longer reserve places in our Ranch Day Program
without pre-paid tuition
Please print off this form and mail it along with Ranch day fee to:
The Flying G Ranch
2759 Patrick Road
Waxahachie, TX 75167
Make checks payable to : The Flying G Ranch
$30 for Basic Ranch Day ($25 for current Riding Club members)
or $50 for Senior Ranch Day ($45 for current Riding Club members)
fee is due with this form.
The Flying G Ranch will email a confirmation upon receipt of this
registration form.
Ask about discounts for groups of 10 or more:
Rider's name: ___________________________________________
Address:__________________________________________________
City:__________________________ Zip: _______________________
Phone:_________________________________________
Rider's Age :___________
D.O.B.___/___/___ M / F
E-Mail Address:_______________________________________
IMPORTANT! Please provide us with an e-mail address where we can send
your confirmation . If you do not have an e-mail address, your confirmation
code will be sent via U.S. mail.
Please turn in this registration form early to provide time for mail travel.
I am signing up for:
_______ Basic Ranch Day ($30.00) ______ Senior Ranch Day ($50.00)
Date of Ranch Day you wish to sign up for:
_______________
(Saturdays Only)
Alternate date in case first date is canceled due to
weather:
_____________________
RIDING INSTRUCTION AGREEMENT AND LIABILITY RELEASE FORM
FOR INDIVIDUALS
THE FLYING “G” RANCH and RIDING STABLES
Herein known as “THIS STABLE”
2759 Patrick Rd.
Waxahachie, TX 75167
PLEASE READ CAREFULLY BEFORE SIGNING. This form must be completed by and for each participant
SERIOUS INJURY MAY RESULT FROM YOUR PARTICIPATION IN THIS ACTIVITY
THIS STABLE DOES NOT GUARANTEE YOUR SAFETY.
A. REGISTRATION OF RIDERS AND AGREEMENT PURPOSE In consideration of the payment of a fee and the signing of this agreement, I, the following listed individual, and the
parent or legal guardians thereof if a minor, do voluntarily request and agree to participate in riding instruction as a student at THIS STABLE, and that this student will either ride
his/her own horse, or school horses provided by THIS STABLE for instructional purpose, today and on all future dates:
B. AGREEMENT SCOPE AND TERRITORY AND DEFINITIONS This agreement shall be legally binding upon the registered student, and the parents or legal guardians thereof if a
minor, my heirs, estate, assigns, including all minor children, and personal representatives, and it shall be interpreted according to the laws of the state and county of THIS STABLE’S
physical location. Any disputes by the rider shall be litigated in, and venue shall be the county in which THIS STABLE is physically located. If any clause, phrase or word is in conflict
with state law then that single part is null and void. The term “HORSE” herein shall refer to all equine species. The term “HORSEBACK RIDING” herein shall refer to riding or
otherwise handling of horses, ponies, mules, or donkeys, whether from the ground or mounted. The term “STUDENT” and/or “RIDER” shall herein refer to a person who rides a
horse mounted or otherwise handles or comes near a horse from the ground. The terms “I”, “ME”, “MY” shall herein refer to the above registered student rider and the parents or
legal guardian thereof if a minor.
C. ACTIVITY RISK CLASSIFICATION I UNDERSTAND THAT: Horseback riding is classifies as RUGGED ADVENTURE RECREATIONAL SPORT ACTIVITY, and that there
are numerous obvious and non-obvious inherent risks always present in such activity despite all safety precautions. According to NEISS (National Electronic Injury Surveillance
Systems of United States Consumer Products) horse activities rank approximately 64th among the activities of people relative to injuries that result in a stay at U.S. Hospitals.
Related injuries can be severe requiring more hospital days and resulting in more lasting residual effects than injuries in other activities.
D. NATURE OF THIS STABLE’S SCHOOL HORSES I UNDERSTAND THAT: THIS STABLE chooses its school horses for their calm dispositions and sound basic training as is
required for use for STUDENT RIDERS and THIS STABLE follows a rigid safety program. Yet, no riding horse is a completely safe horse. Horses are 5 to 15 times larger, 20 to 40
times more powerful, and 3 to 4 times faster than a human. If a rider falls from horse to ground it will generally be at a distance of from 3 1/2 to 5 1/2 feet, and the impact may result in
injury to the rider. Horseback riding is the only sport where one much smaller,weaker predator animal (human) tries to impose its will on, and become one unit of movement with,
another much larger, stronger prey animal with a mind of its own (horse) and each has a limited understanding of the other. If a horse is frightened or provoked it may divert from its
training and act according to its natural survival instincts which may include, but are not limited to: stopping short; changing directions or speed at will; shifting its weight; bucking,
rearing, kicking, biting, or running from danger.
E. RIDER RESPONSIBILITY I UNDERSTAND THAT: Upon mounting a horse and taking up the reins the rider is in primary control of the horse. The rider’s safety largely depends
upon his/her ability to carry out simple instructions, and his/her ability to remain balanced aboard the moving animal. I agree that the rider shall be responsible for his/her own safety,
including that of an unborn child, if the rider is pregnant. Pregnant women should ride horses only under the advice of their physician. THIS STABLE advises pregnant women not to
ride horses.
F. CONDITIONS OF NATURE AND INSPECTION OF PREMISES I UNDERSTAND THAT: THIS STABLE is NOT responsible for total or partial acts, occurrences, or elements
of nature that can scare a horse, cause it to fall, or react in some other unsafe way. SOME EXAMPLES ARE: Thunder, lighting, rain, wind, wild and domestic animals, insects,
reptiles, which may walk, run, or fly near, or bite or sting a horse or a person, and irregular footing on out-of-door groomed or wild land which is subject to constant change in
condition according to weather, temperature, and natural and man-made changes in landscape. The rider and parent or legal guardian have inspected THIS STABLE’S facilities and
are satisfied that all premise conditions are reasonably safe for rider’s intended purpose, usage and presence upon THIS STABLE’S PREMISES.
G. SADDLE GIRTH/NATURAL LOOSENING I UNDERSTAND THAT: saddle girths (saddle fasteners around horse’s belly) may loosen during a ride. If a rider notices this he/she
must alert the riding instructor as quickly as possible so action can be taken to avoid slippage of saddle and a potential fall from the animal.
H. ACCIDENT/MEDICAL INSURANCE I AGREE THAT: Should an emergency medical treatment be required, I and/or my own accident/medical insurance company shall pay for
all such incurred expenses. My accident/medical company is _____________________________ and my policy number is _______________
I. PROTECTIVE HEADGEAR WARNING I AGREE THAT: I for myself and on behalf of my child and/or legal ward have been fully warned and advised by THIS STABLE that
protective headgear which meets or exceeds the quality standards of the SEI CERTIFIED ASTM STANDARD F 1163 Equestrian helmet, should be purchased and worn while riding
and being near horses and that I do understand that the wearing of such headgear at these times may reduce the severity of some of the wearer’s head injuries and possibly prevent
the wearer’s death from happening as the result of a fall and other occurrences.
J. LIABILITY RELEASE I AGREE THAT: in consideration of THIS STABLE allowing my participation in this activity, under the terms set forth herein, I, the RIDER, for myself and on
behalf of my child and/or legal ward, heirs, administrators, personal representatives or assigns, do agree to hold harmless, release, and discharge THIS STABLE, its owners, agents,
employees, officers, directors, representatives, assigns, members, owners of premises and trails, affiliated organizations, and Insurers, and others acting on its behalf (hereinafter,
collectively referred to as “Associates”), of and from all claims, demands, causes of action and legal liability, whether the same be known or unknown, anticipated or unanticipated,
due to THIS STABLE’S and/or ITS ASSOCIATES ordinary negligence; and I do further agree that except in the event of THIS STABLE’S gross negligence and willful and wanton
misconduct, I shall not bring any claims demands, legal action, against THIS STABLE and ITS ASSOCIATES as stated above in this clause, for any economic and non-economic
losses due to bodily injury, death, property damage, sustained by me and/or my minor child or legal ward in relation to the premises and operations of THIS STABLE, to include while
riding, handling, or otherwise being near horses owned by or in the care, custody and control of THIS STABLE, whether on or off the premises of THIS STABLE.
K. EQUINE ACTIVITY LIABILITY ACT WARNING I ACKNOWLEDGE THAT I have reviewed this state’s EQUINE ACTIVITY LIABILITY ACT WARNING which is written below
and incorporated by reference herein.
ALL RIDERS AND PARENTS OR LEGAL GUARDIANS MUST SIGN BELOW AFTER READING THIS ENTIRE DOCUMENT:
TEXAS WARNING
UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), AN EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A
PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES.
Medical and liability release:
I, the undersigned, am the parent or guardian having control or custody of the above named child. I grant my child permission to attend The Flying “G” Ranch. I certify that my child
is physically and mentally fit for all camp and equestrian activities and will obey all camp staff and rules. I grant my permission in case of injury, accident or illness for my child to be
treated by any licensed physician or member of camp staff and agree to pay for all such treatment. Further, I also grant permission that my child’s photo may be used in any future
brochures or promotions for The Flying “G” Ranch.
WARNING which is written below and incorporated by reference herein.
ALL RIDERS AND PARENTS OR LEGAL GUARDIANS MUST SIGN BELOW AFTER READING
SIGNER STATEMENT OF AWARENESS
I/WE THE UNDERSIGNED, HAVE READ AND DO UNDERSTAND THE FOREGOING AGREEMENT, WARNINGS, RELEASE AND ASSUMPTION OF RISK, I/WE
FURTHER ATTEST THAT ALL FACTS RELATING TO THE APPLICANT’S PHYSICAL CONDITION, EXPERIENCE, & AGE ARE TRUE AND ACCURATE.
We cannot accept liability release forms that are
incomplete or altered in any way.
_______________________________________________________________________________
SIGNATURE OF PARENT OR GUARDIAN NAME (PLEASE PRINT) DATE
ADDRESS IN FULL: ___________________________ HOME PHONE #________________________
____________________________ EMERGENCY PHONE # ____________________
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Spring 2010
April 3
No Ranch Day
April 10
April 17
April 24
May 1
May 8
May 15
May 22