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Hillside Meadows Equestrian Center
111 George Hill Rd. - Grafton, MA 01519
508-887-990 - www.hillside-meadows.com
STUDENT / BOARDER INFORMATION AND WAIVER FORM

Name of Student/Boarder: Date of Birth
Name of Parent (if student is under 18 yrs of age)
Address
City State Zip
Telephone Home Cell
Email Address
Emergency Phone Name
Medical Insurance Carrier

I fully understand the risks inherent in horseback riding and certify that I,(my child) ride at my own risk. Further, I agree to hold harmless and not bring suite against Hillside Meadows Equestrian Center., nor their Owners, Heirs, Agents,employees, subcontracted employees, Land Owners or Hillside Meadows LLC, for any accident, personal injury, damage, or loss that may occur while riding under the supervision of Hillside Meadows Equestrian Center, or their Agents or during unsupervised riding in preparation of, or cessation of, supervised instruction, or during trail or pleasure riding at Hillside Meadows Equestrian Ctr. located at: 111 George Hill Rd. in Grafton, MA, or on surrounding landowners land. I understand and acknowledge that any horseback riding activites engaged in will require physical execution and inherent risk of injury and I am aware of said potential injury including, but not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death and furthermore that participation has the inherent risk of exposure to COVID-19 and the potential of contracting said virus; I also agree that photographs and or video of me or my child may be used on the farms website or otherwise for the purpose of advertising.

I agree to wear a hard hat helmet at all times while mounted on horseback. I will also familiarize myself with the barn rules.

I, by signing this form below, do agree to take full personal responsibility for my or my childs decision to ride and be in personal contact with horses. I also agree to adhere to barn rules and policies, which have been made aware to me in the following form.

Level of your riding ability:

WARNING Under Massachusetts Law, 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, pursuant to Chapter 128, Section 2D of the MASS. General Laws.

SIGNED Date
(Parent's signature if student is under 18 yrs of age)
WITNESSED Date
(For Hillside Meadows Equestrian Center)