Rider Application Form

I, PLEASE TYPE NAME BELOW, authorize Shoulder to Shoulder Ranch to receive information from any law enforcement agency, including police departments and sheriff’s departments, of this state or any other state or federal government, to the extent permitted by state and federal law, pertaining to any convictions I may have had for violations of state or federal criminal laws, including but not limited to convictions for crimes committed upon children or animals. I understand that such access is for the purpose of considering my application as an employee/volunteer, and I expressly DO NOT authorize the non-profit, its directors, officers, employees, or other volunteers to disseminate this information in any way to any other individual, group, agency, organization, or company.

Under Nebraska 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 section 25-21, 249 to 25-21, 253. I/We would like to participate in Shoulder to Shoulder Ranch and/or will be on the premises that Shoulder to Shoulder Ranch occupies. I acknowledge the risks and potential for risks in riding, working with horses, being near horses, and being an observer on the Shoulder to Shoulder Ranch property. However, I feel that the possible benefits to myself/my child/my ward are greater than the risk assumed. I hereby, intending to be legally bound, of myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against Shoulder to Shoulder Ranch, its Board of Directors, Instructors, Therapists, Volunteers, Employees, and/or against Double Stream Arabians or owners for any and all losses I and/or my child and/or my ward may sustain while participating in the Shoulder to Shoulder Ranch program or while on the property Shoulder to Shoulder Ranch occupies.

The Photographed Party/Parties hereby grants consent to Shoulder to Shoulder Ranch and authorizes the use of all media, reproduction of media in any form whatsoever and in any derivative work based thereon, and to use them to publicize, promote and advertise. The photographed Party/Parties also consent to the use of their own name or any other names that they are known as. The photographed Party/Parties hereby releases any and all claims whatsoever forevermore in connection with the use of the photograph and name and the reproduction thereof as aforesaid. The Photographed Party/Parties hereby waives any right the they may have to inspect and/or approve the advertising copy that may be used in connection therewith or the use to which it may be applied. THE PHOTOGRAPHED PARTY/PARTIES WARRANTS THE THEY ARE THE UNDERSIGNED AND THAT THEY HAVE READ THIS CONSENT AND RELEASE PRIOR TO THE SIGNING OF THE DOCUMENT, THAT THE UNDERSIGNED UNDERSTANDS IT, AND THAT THE UNDERSIGNED FREELY ENTERS INTO THIS CONSENT AND RELEASE.

I understand that all information (written and verbal) about participants at Shoulder to Shoulder Ranch is confidential and will not be shared with anyone without the expressed written consent of the participant and his/her parent/guardian in the case of a minor.

I agree to give Shoulder to Shoulder Ranch a one week notice if I am unable to attend a lesson due to schedule absences, such as a vacation or other appointments.

I understand that the information provided above is accurate to the best of my knowledge. I know of no reason why I should not participate in Shoulder to Shoulder’s programs. By typing my signature below, I verify that I accept all of the previously agreed-upon terms, conditions, and responsibilities outlined in this document. I acknowledge that my electronic signature carries the same legal weight as a handwritten signature.