EQUINE RELEASE AND WAIVER OF LIABILITY,
ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT
BREEZY BLUFF RIDING ACADEMY ,
RUSS BROADFIELD AND BETTY BROADFIELD
Name: age Name: age_____
Name: age Name: age_____
(ages if under 21)
Does this rider have any physical and or mental health conditions or disorders which may affect his or her safety and
ability to ride equine? ____no ____yes.. if yes explain on reverse side please
I hereby enter into this agreement in consideration of my/or my child’s ability and permission to ride, drive, handle OR
use any Equine owned by, or boarded by
Breezy Bluff Riding Academy, Russ Broadfield, or Betty Broadfield
Whose address is 3634 N 685 East Rd McLean, IL
This agreement shall be legally binding upon me the registered student, and the parents or legal guardians thereof if
a minor, heirs, estate, assigns, including all minor children and personal representatives; and it shall be interpreted
according to the laws of the state and county of this stable's physical location. Any disputes by the rider shall be
litigated in, and venue shall be the county in which this stable is physically located, If any clause, phrase, or word is in
conflict with state law, then that single part is null and void. The term "horse" herin shall refer to all equine species.
The term "horseback riding" herin shall refer to riding or otherwise handling of horses, ponies, mules, or donkeys,
whether from the ground or mounted, the terms "student" and or "rider" shall herin refer to a person who rides a
horse mounted or otherwise handles or comes near a horse from the ground, the terms "I, Me, My" shall herin refer to
the above registered student rider and the parents thereof if a minor.
BY SIGNING THIS AGREEMENT YOU ARE GIVING UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO
RECOVER DAMAGES IN CASE OF INJURY, DEATH, OR PROPERTY DAMAGE, ARISING OUT OF YOUR BEING
PRESENT AT THE FARM, RIDING OR USING OF THE OWNER’S EQUINES AND/OR PARTICIPATION IN EQUINE
ACTIVITIES AT Breezy Bluff Riding Academy or at events attending with the stable , INCLUDING INJURY, DEATH, OR
PROPERTY DAMAGE ARISING OUT OF THE NEGLIGENCE OF YOU OR BREEZY BLUFF RIDING ACADEMY
READ THIS AGREEMENT CAREFULLY BEFORE SIGNING IT. YOUR SIGNATURE INDICATES YOUR
UNDERSTANDING OF AND AGREEMENT TO ITS TERMS.
By signing this form, I hereby acknowledge on behalf of myself that I have familiarized myself with the activities that I
will be allowed to participate in, and that I do hereby acknowledge and agree that I will participate in these activities
without restriction or limitation
I UNDERSTAND THAT: HORSE BACK RIDING IS CLASSIFIED AS A RUGGED ADVENTURE RECREATIONAL SPORT
ACTIVITY, and that there are numerous obvious and non-obvious inherent risks always present in such activity
despite all safety precautions. According to NEISS (National Electronic Injury Surveillance Systems of United States
Consumer Products) horse activities rank 64th among the activities of people relative to injuries that result in a stay at
U.S. hospitals. Related injuries can be severe requiring more hospital days and resulting in more lasting residual
effects than injuries in other activities.
I understand and accept that riders under the age of 5 present greater risk than those over 5 yrs _______initial
CONTINUED ON PAGE 2
I recognize the inherent risks involved in riding and working with horses, including but not limited to:
Bites, kicks, abrasions or contusions from horses.
Being thrown or bucked off by horses.
Scratches or other injury from stalls or enclosures.
Scratches or other injury from grooming tools and other equine equipment and tack.
Allergic reactions to animals, hay, or other allergens.
Tripping in holes or on materials or equipment. Being Stepped on by a horse.
Slipping, falling, or otherwise being injured in the barn, in stalls, or on the grounds, which can be slippery,
muddy, wet, or contain or present other hazards.
I REALIZE THAT I AM SUBJECT TO THE ILLINOIS EQUINE LIMITED LIABILITY ACT
Under the Equine Liability Act, each participant who engages in an equine activity expressly assumes the risks of
engaging in and the legal responsibility for injury, loss, or damage to person or property resulting from the risks of
I hereby specifically forever waive and release Breezy Bluff Riding Academy and its principals and agents from any
liability for injury arising out of the inherent risks from riding, working or participating in a stable environment and/or
with horses, as well as from the active negligence of Breezy Bluff Riding Academy, its principals and agents.
By signing this agreement I hereby acknowledge that although there may be supervision during my time spent at
Breezy Bluff Riding Academy there will not be a nurse on the premises and Breezy Bluff Riding Academy, Russ
Broadfield, Betty Broadfield and its principals and agents bear no responsibility for my health or medical care.
I agree to indemnify, save and hold harmless Breezy Bluff Riding Academy and its principals and agents from and
against any loss, liability, damage, attorneys’ fees, or costs that they may incur arising out of or in any way connected
with either my presence or participation at Breezy Bluff Riding Academy or any acts or omissions of Breezy Bluff
Riding Academy principals or agents. This includes property damages.
By signing this Agreement, and by initialing the paragraph below, I hereby acknowledge my complete understanding,
agreement and consent to my presence and/or participation in the activities at Breezy Bluff Riding Academy or events
off farm with Breezy Bluff Riding Academy, without restriction, without liability to Breezy Bluff Riding Academy, its
principals or agents, and with full knowledge and understanding of the disclosures, waivers, and releases herein. I
understand and can read English.
If I am present at and participate in the activities of Breezy Bluff Riding Academy I do so at my own risk, and I hereby
acknowledge and agree that Breezy Bluff Riding Academy and/or any of its principals and agents shall bear no
responsibility or risk associated with injuries that could arise from my presence or participation at Breezy Bluff Riding
Academy or at its off farm events.
I give permission for photos taken to be used by BBRA for promotional activities-- not identifying minor children by
Medical Insurance company __________________________policy number__________________REQUIRED
Parent’s Signature: _______________________________________ Date:________________________
(if participant is under 21)
Participant’s Signature: _______________________ Participant’s Signature: ______________________