Blue Barn Ranch Informed Consent
Name: ___________________________________________ Age:________________
Address: _________________________________________
City/State: ________________________ Zip: ___________
Home Phone: ______________ Cell Phone: ___________
The above named understands and agrees that there are risks inherent in dealing with horses and ponies. Some of the inherent risks include:
- The propensity of an equine to behave in ways that may result in injury, death or loss to persons on or around the equine. No horse is a completely safe horse. If 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 suddenly; changing direction or speed at will; shifting its weight from side to side; bucking; rearing; biting; kicking; pulling back or running from danger.
- The unpredictability of an equine’s reaction to sounds, sudden movements, unfamiliar objects, persons, or other animals.
- That there may be hazards including, but not limited to, ground surface or subsurface conditions.
- The possibility of a collision with another equine, another animal, a person, or an object.
- The potential of an equine activity participant to act in a negligent manner that may contribute to injury, death, or loss to the above named person, or to other persons, including, but not limited to failing to maintain control over an equine or failing to act within the ability of the participant.
I acknowledge that I have read this Informed Consent Document and know and understand its contents.
Signature: __________________________________________ Date: ______________
If above named is a minor, the parent or legal guardian must complete and sign below.
I, the undersigned parent or guardian of the above participant, in consideration of my minor’s participation at Blue Barn Ranch, agree and understand the risks inherent in dealing with horses and ponies. I acknowledge that I have read this Informed Consent Document and know and understand its contents.
Name: ____________________________ Phone: _____________
Address: ________________________
City/State: _________________ Zip:_______
Signature: ________________________ Date: ______________
Blue Barn Ranch – 3070 Yucca Mesa Road – Yucca Valley, CA 92284
Blue Barn RanchRelease of Liability and Hold Harmless Agreement:
Name: _______________________________Age: ______________
Address: ________________________________________________
City/State: _____________________________Zip: _______________
Home Phone: _______________ Cell Phone:_________________
I, the above named, have read and do understand, and freely and voluntarily do enter into
This Release of Liability and Hold Harmless Agreement with Kathi R. Savacool, John W.
Savacool (“its owners”), their heirs, agents, employees and volunteers, doing business as
Blue Barn Ranch (“Company”), understanding that this Release of Liability and Hold
Harmless Agreement is a waiver of any and all liability(ies).
I understand the potential dangers that I could incur in mounting, riding, walking,
exercising, boarding, feeding said horse; including but not limited to, any interactions with other horses and dogs. Understanding those risks I hereby release that Company, its
owners, their heirs, agents, employees, volunteers and anyone else directly or indirectly
connected with that Company from any liability whatsoever in the event of injury or
damage of any nature (or perhaps even death) to me or anyone else caused by or
incidental to my electing to mount and ride a horse, or be a spectator at such event, at Blue Barn Ranch.
I agree that I will indemnify and hold harmless riding instructors/trainers (hereinafter
referred to as independent instructors), therapists, Blue Barn Ranch, its owners, their
heirs, agents, employees and volunteers against all claims, demands, and causes of action, including court costs, and actual attorney fees, arising from any proceedings or lawsuits brought by or prosecuted for my benefit, in which this release is upheld.
I hereby release Blue Barn Ranch, its owners, their heirs, agents, independent instructors, therapists, employees and volunteers from all liability for any act of negligence or want of ordinary care on the part of the aforementioned. In consideration of my participation in events organized or sponsored by Blue Barn Ranch, I waive, release, and discharge Blue Barn Ranch, its owners, their heirs, agents, independent instructors, employees and volunteers from any and all claims of liability for injury or damage to myself, my animals, or property arising out of my participation. This agreement is binding upon my executor, heirs, and assigns.
I am responsible for the supervision, safety and well being of any guest or family members who may accompany me to Blue Barn Ranch. I have received a copy of Blue Barn Ranch’s Safety Rules and will adhere to them strictly. This agreement shall continue for each and every visit to Blue Barn Ranch.
Blue Barn Ranch Release of Liability and Hold Harmless Agreement Page 1 of 2
Blue Barn Ranch, its owners, their heirs, agents, independent instructors, employees and volunteers shall not be liable for theft of property or any damage to person, horse or property that may accrue from any cause or as a result of fire, flood, earthquake, rain or snow storms, wind, up to and including tornadoes, escape, health, injury or death. I have inspected the boarding and riding facilities, grounds, arenas, round pens and equestrian path. I accept their condition as safe for horses and people.
I understand that Blue Barn Ranch requires all riders, while mounted to wear ATSM approved helmets and heeled boots. My initials indicate that I am 18 or more years of age and that I chose to wear a helmet at my discretion. ________________
I understand that Blue Barn Ranch from time to time takes photos of students riding or working with horses. This release acts as a photo release and I grant permission to allow Blue Barn Ranch to use the photos in promotional materials, web pages, print media or news media.
I addition, in the event that I am injured or become ill and am not conscious or otherwise capable of making an informed decision regarding my medical care, I hereby consent to such emergency care and emergency calls as are deemed necessary and prudent by Blue Barn Ranch staff until a medical professional arrives, or until such time as I regain consciousness, or the designated person below can be reached and consent to or decline treatment on my behalf. I agree to hold Blue Barn Ranch, its owners, their heirs, agents, employees, independent instructors and volunteers harmless for care given in such an emergency situation and I agree that I am responsible for all cost incurred as a result of the accident.
I acknowledge that I have read this Release of Liability and Hold Harmless Agreement and know and understand its contents.
Signature: _____________________________ Date: ____________
If above named is a minor, the parent or legal guardian must complete and sign below.
I, the undersigned parent or guardian of the above participant, in consideration of my minor’s participation at Blue Barn Ranch, agree that the terms and conditions of this Release of Liability and Hold Harmless Agreement shall be binding as to damage or injury to my minor, our animal, and property arising out of his/her participation on or off the premise. I acknowledge that I have read this Release of Liability and Hold Harmless Agreement and know and understand its contents.
Name: ________________________________ Phone: ____________
Address: ____________________________ City/State: ____________ Zip: _____
Signature: _____________________________ Date: _____________ Blue Barn Ranch – 3070 Yucca Mesa Road – Yucca Valley, CA 92284
Blue Barn Ranch Safety Rules
Blue Barn Ranch is committed to providing a rewarding and safe experience for our clients and the horses who reside here. In order to accomplish this, Blue Barn Ranch sets forth this list of rules which must be strictly adhered to by all clients, family members, volunteers and guests. Thank you for your cooperation!
>No smoking, alcohol or illegal drugs at Blue Barn Ranch.
>Please obey all posted signs.
>All mounted riders must wear approved ATSM helmets and heeled boots.
>No non-resident horses, dogs or animals at Blue Barn Ranch.
>Please do not feed or handle horses and dogs owned by others.
>No playing of music or profanity.
>All guests or family members will be properly supervised.
>Please keep your equipment and area safe and neat.
>No borrowing equipment or supplies owned by others.
>Ride and drive in designated areas only.
>Gates open at 7 a.m. & horse activities conclude by dusk.
>Please don’t litter!
Blue Barn Ranch – 3070 Yucca Mesa Road – Yucca Valley, CA 92284-9276