HIGH POINT STABLES, LLC

RELEASE FORM

Name of rider or participant: ________________________________________________

Address: ________________________________________________________________

_______________________________________________________________________

Date of birth (if minor): _________________

Phone #: _______________________

In case of an emergency contact: _____________________________________________

Phone #: _______________________

WARNING:

Under the Michigan Equine Liability Act, an equine professional may not be liable for an injury to or the death of a participant in an equine activity. The undersigned does hereby acknowledge that horseback riding is inherently dangerous and agrees to hold blameless High Point Stables, LLC, it’s owners, employees, agents, and landlords including Lindsey VanderLaan, Jason VanderLaan, Casey Flietstra, Pat Flietstra, and any other affiliates or representatives from any and all liability for death, personal injury of any type, and loss to personal equipment or property. This release shall also constitute a release of any and all liability beyond the provisions of the Michigan Equine Liability Act [1994 PA 351] to High Point Stables, LLC, its owners, employees, agents, and landlords.

Signature: _____________________________

Date: _______________

If minor, parent or court appointed guardian signature: ___________________________

Date: ________________