WARNING: Under Florida law equine activity sponsor, an equine professional, or any other person, which shall include a corporation or partnership, shall not be liable for an injury to or the death of a participant resulting from the inherent risks of equine activities. Neither participant, nor any participant’s representative shall have any claim against or recover from any equine activity sponsor equine professional, or any other person for injury, loss, damage, or death of the participant resulting from of the inherent risks of equine activities. Florida Statutes: 773.051. the undersigned, have read the above and been informed and by my signature on this form acknowledge, that I understand there is a risk of bodily injury involved in horseback riding and/or related activities carried on at Barb Koster’s riding facility located 14401 W. Palomino Dr., Southwest Ranches, Fl. Therefore, I release and hold harmless the employees and agents of her facilities and Barb Koster from any and all responsibility resulting from any injuries.

I hereby give my permission for my son/daughter: _________________________________

to participate in all activities involved in the riding program at Barb Koster’s riding facility including, but not limited to: horseback riding, and horse shows. I also give my permission allowing my child to be transported to and participate in activities at other locations including,

but not limited to field trips such as horse shows.

Parent’s Name: ______________________________ Parent’s Signature_________________________________

Address: ____________________________________________________________________________________________


        THIS AGREEMENT AND AUTHORIZATION is by and between Barb Koster, from herein referred to “Management, “ and _____________________________________________________ , from herein referred to as “Parent.”

        Management is hereby authorized to obtain any and all medical treatment that management deems necessary for my minor child and /or children.

        Parent of guardian agrees to bear any cost connected therewith and shall pay promptly upon billing by the healthcare provider. Management shall incur no financial liability for medical treatment obtained pursuant to this authorization.

Name(s) of child(ren)                        Is your child on any medication? Please list:

________________________________                        ___________________________________________________

________________________________                        Does he/she have any allergies? Please list:

_________________________________                ____________________________________________________

Health Insur. Company: _____________________________Primary Healthcare Provider ______________________________

Parent’s signature: ___________________________________ Parent’s Name: _____________________________________________

EMERGENCY CONTACT INFO: Name _____________________________________ Phone: ________________________________

2nd EMERGENCY CONTACT INFO: Name:__________________________________ Phone: _______________________________

Date:______________________________________ Parent’s signature: _________________________________________________