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Official PSP Registration

Horseback Riding Lessons


Participants Name_______________________________________________ Age______

Participants Name_______________________________________________ Age______

Participants Name_______________________________________________ Age______

Participants Name_______________________________________________ Age______

Participants Name_______________________________________________ Age______

[At least one parent/guardian must stay with their minor child]

Parents/Guardians Name______________________________________

Parents/Guardians Name______________________________________

Home Phone Number ( ) - Cell Phone Number ( ) -

Email______________________________________

Street address___________________________________ City_____________________________

State CA Zip_______________

What PSP / support group are you enrolled?

_______________________________________________________________________

Are ANY family members enrolled in a public school program (this includes day campus, ISP, or
charter school)? Yes No
AGREEMENT AND RELEASE OF LIABILITY

I, the undersigned, understand the following:


I, the registrant, or the parent/guardian of the registrant, a minor, agrees that we will abide by
the rules of PSP Sports. I am aware that recreational activities can be hazardous and I am
voluntarily participating in these activities with knowledge of the hazard involved and hereby
agree to accept any and all risks of injury or death. PSP Sports is not responsible for participant’s injuries or damages
occurring from “hazardous recreation activities.” PSP Sports does not provide participants with medical insurance or
treatment for injuries. I agree to hold harmless and release PSP Sports, its officers, agents and employees from any and all
liability arising from or related to my participation in PSP Sports program activities (including equestrian activities, such as
the riding, use of, or being near horses, whether at an arena, stable or on a trail ride in association with PSP Sports). This
release includes, but is not limited to, all liability for death, personal injury or property damage resulting from the active or
passive negligence of PSP Sports or its agents or any defective or hazardous condition of any property or equipment owned,
or facilities utilized by PSP Sports. I am responsible for any loss, theft or damage to personal or PSP Sports equipment,
articles or facilities while using said equipment, articles and/or facilities.
Nature of Horses.
I understand that no horse is completely safe, and the PSP Sports officers, agents, and employees make no representations or
guarantees regarding the safety, training or suitability of any horse. A horse may divert from its training and act according to
its natural survival instincts and may abruptly change directions or speed, trip, slip, fall, stop short, shift its weight, buck, rear,
kick, bite, spook, or run from what it perceives to be danger if it is frightened or provoked, or for no reason whatsoever.
Usage of Helmets
I am aware that protective head gear which meets or exceeds the quality standards of the SEI certified and ASTM standard
F1163 equestrian helmet, should be worn by me and/or my child while riding and being near horses, and the wearing of such
helmet may reduce the severity of some head injuries and may prevent my serious injury or death as a result of a fall or other
occurrence. I also understand that WEARING A HELMET IS MANDATORY FOR PSP SPORTS LESSON PROGRAM.

Rules and Payment of Fees


I have read and agree with the Rules and Payment of Fees document.

Participant Signature ____________________________________ Date ____________________________


Or
Parent/guardian Signature ________________________________ Date ___________________________

AGREEMENT WITH STATEMENT OF FAITH, HOME EDUATION PHILOSPHY,


CODE OF CONDUCT, AND DRESS CODE

By signing this agreement, I affirm that I have read the Statement of Faith, Code of Conduct, and Dress Code; that I agree
with the Statement of Faith, and that I and my family will abide by the Code of Conduct and Dress Code at every PSP Sports
event. I have no family member enrolled in a public school program (including day campus, ISP, or charter school).

Participant Signature ____________________________________ Date ____________________________


Or
Parent/guardian Signature ________________________________ Date ___________________________

AUTHORIZATION FOR USE OF PHOTOS

I give permission for use of photos taken of me and/or my child (ren) during recreation programs and related activities to be
used for publicity purposes in brochures, flyers, news releases and other print or broadcast media.

Participant Signature ____________________________________ Date ____________________________


Or
Parent/guardian Signature ________________________________ Date ___________________________