Client Form

Address*:

Additional Contact Person Name and #:

Preferred/Attending Body Worker:

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Please give us any applicable information with regards to any prior diagnosis/recommendations/therapies/injuries:

Teeth Last Done:

When requested and with the approval of the HORSE OWNER, Central Alberta Equine Rehab and Wellness Centre. will
use the services of professional partners such as veterinarians, equine chiropractors, equine acupuncture practitioners,
equine massage therapists, corrective farrier practitioners, equine dentist and nutrition specialists, or any other holistic
resource the HORSE OWNER may wish to utilize. Payment for the above services is not included in the monthly
Rehabilitation and Conditioning fee, and will be itemized separately on the bill. Travel and mileage expenses to be
determined on a per trip basis.

• It is recommended that the HORSE OWNER obtain veterinary approval before the start of any treatment, Rehabilitation
or Conditioning program;

• We will refer clients to other appropriate practitioner(s) when deemed necessary;
• We do not diagnose medical conditions, ailments or injuries, but will work with professional partners to assess and
make suggestions;

• We do not make any guarantees as to the outcome of any treatment, rehabilitation or conditioning program;

• We will refer the horse back to its veterinarian should they suspect any negative medical condition, ailment or injury.

Any additional care (Back on track, etc):

Read This Agreement Carefully Before Signing.

HORSE(S) ILLNESS OR INJURY REQUIRING EMERGENCY CARE

I/WE AGREE THAT Should the horse(s) become sick or injured, that Central Alberta Equine Rehab and Wellness Centre will attempt to notify The HORSE OWNER at the above Emergency Telephone Number. If Central Alberta Equine Rehab and Wellness Centre is not able to contact you quickly in an emergency situation such as your horse(s) becomes injured (eg. breaks a leg) or becomes ill (eg. colic) and needs immediate Veterinary Care, Central Alberta Equine Rehab and Wellness Centre. is given the authority to obtain the services of a veterinarian of their choice, and Central Alberta Equine Rehab and Wellness Centre can provide any other necessary measures to attempt to maintain and/or improve the health and life of the horse(s).

The HORSE OWNER shall promptly pay all expenses for all services upon billing. The horse(s) Illness or Injury Requiring Emergency Care clause, includes all horses included on Form, owned by the HORSE OWNER. As THE HORSE OWNER, I agree that Central Alberta Equine Rehab and Wellness Centre has the right to insist that all horses on their premises are treated in an ethical and humane manner. The following waiver of all claims, release from all liability, assumption of all risks, agreement not to sue or undertake any form of litigation and other terms here within are entered into by me (the HORSE OWNER) with and for the benefit of Central Alberta Equine Rehab and Wellness Centre their directors, officers, employees, representatives, agents, officials, volunteers, business operators, equine owner(s), and site property owners, (all of them collectively called Central Alberta Equine Rehab and Wellness Centre). I am aware and understand that there are inherent DANGERS, HAZARDS, and RISKS, (collectively called RISKS) associated with Equine Activities.

1. I the HORSE OWNER acknowledge that these inherent "RISKS" of Equine Activities mean those DANGEROUS conditions which are an integral part of Equine Activities, including but not limited to: a) The potential for permanent injury, permanent paralysis and death, from situations such as, but not limited to; i) being kicked by a horse ii) falling from or being bucked off of a horse iii) being hit or run over by a horse iv) collisions with other horses or objects b) The tendency of horses to behave in ways that may result in injury, harm, or death to persons on or around them; c) The unpredictability of a horse's reaction to such things as sounds, sudden movement, and unfamiliar objects, persons, or other animals; d) Certain hazards such as surface and subsurface conditions;

2. Each individual who engages in an equine activity expressly assumes the risk of, and legal responsibility for injury, loss, or damage to the participant or the participant's property that results from participating in an equine activity. Each participant shall have sole individual responsibility for knowing the range of his or her own ability to manage, care for, and control a particular horse or perform a particular equine activity. It shall be the duty of each participant to act within the limits of the participant's own ability, to maintain reasonable control of the particular horse or horses at all times while participating in an equine activity, to heed all posted warnings. And to perform equine activities only in an area or in facilities designated by the horseman, and to refrain from acting
in a manner that may cause or contribute to the injury of anyone.

The HORSE OWNER ACKNOWLEDGES THAT

During the time that the horse(s) are at Central Alberta Equine Rehab and Wellness Centre, the horse(s) shall be in the custody of Central Alberta Equine Rehab and Wellness Centre. The HORSE OWNER has inspected Central Alberta Equine Rehab and Wellness Centre, premises and/or has in some other way satisfied themselves that the
condition of the premises and the facilities will provide an adequate and reasonable level of safety for OWNER’S horse(s) and OWNER’S family, guests and visitors who enter the premises. Central Alberta Equine Rehab and Wellness Centre will exercise reasonable care for the protection of the horse(s) and shall provide care for the
horse(s) to the best of their ability.

It is understood that each animal is unique and that Central Alberta Equine Rehab and Wellness Centre cannot guarantee the results or degree to which the horse(s) will be conditioned and or rehabilitated. The HORSE OWNER further understands that the rehabilitation and conditioning of a horse involves placing the horse in a unique environment, which may cause stresses on the horse(s), both physically and mentally, and that the Central Alberta Equine Rehab and Wellness Centre is not responsible for the results of these stresses that could potentially cause injury, illness and/or loss of horse(s) by death.

The HORSE OWNER fully understands and hereby acknowledges that Central Alberta Equine Rehab and Wellness Centre. does not carry any insurance on any horse that is not owned by Central Alberta Equine Rehab and Wellness Centre, including, but not limited to, such insurance for boarding, or rehabilitation and conditioning or any other purposes, for which the horse is covered under any public liability, accidental injury, theft or equine mortality insurance, and that all risks relating to boarding of horses or rehabilitation and conditioning, or for any other reason, for which the horse is in the possession of Central Alberta Equine Rehab and Wellness Centre are to be borne by the HORSE OWNER.

The HORSE OWNER is responsible for any and all damages, injuries, or loss of life caused by or to the HORSE while in the care, custody or control of the Central Alberta Equine Rehab and Wellness Centre, to The HORSE OWNER, OWNER’S family members, and invitees or other handlers or agents appointed by them. The HORSE OWNER is also responsible for accidents, injuries, and loss of life sustained by The HORSE OWNER, The HORSE OWNER’S family members, invitees, and agents caused by or in relation to The HORSE OWNER’S horse(s).

As The HORSE OWNER I agree that this waiver and all terms contained herein are governed exclusively and in all respects applicable Provincial and Federal Laws in which the “Equine Activities” are provided by the “Central Alberta Equine Rehab and Wellness Centre” I hereby irrevocably submit to the exclusive jurisdiction of the courts of the Province of Alberta and Canada and I agree that no other court can exercise jurisdiction over the terms and claims referred to herein.