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Typing your full name below serves as your signature
Thank you for retaining Pinnacle Rehab Center as your provider of horse rehabilitation and conditioning services. This Horse Rehabilitation and Conditioning Agreement (“Agreement”) will govern the services we provide at the request of the Horse Owner (“Client”) or at the request of Client’s Agent (identified below). This Agreement applies to all horses owned or leased by Client and applies to any and all services provided by Pinnacle Rehab Center, including but not limited to, Vita-Floor, Hudson AquaPacer+, Rehab Riding, Class IV Laser, Game Ready, Activo-Med PEMF Blanket, Hotwalker, Turnout, Lunging, Hand-Walking, Wrapping, Stretching/Physical Therapy, Equicore Products, Back on Track Products, Bandaging, Ice/Heat Therapy (collectively “Services”), to any and all horses on Client’s behalf, whether or not the horse(s) is listed below.
THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS – READ CAREFULLY BEFORE SIGNING
Horse Information
If Applicable, Trainer Information
Owner Information
Horse’s Injury/Surgery Information (if applicable)
*Please email us all current medical records, discharge paperwork and any imaging*
- I understand that during the performance of the Services, unforeseen conditions may be revealed that necessitate an extension or different Services than those requested. Therefore, I hereby consent to and authorize the performance of such other Services as are deemed necessary and desirable in the exercise of the Pinnacle Rehab Center’s professional judgment. I understand that Pinnacle Rehab Center support personnel will be utilized as deemed necessary by the Pinnacle Rehab Center service provider.
- I have been advised as to the nature of the Services and the risks involved. I acknowledge that the results cannot be guaranteed. I understand and agree that horses are inherently unpredictable and prone to injury, illness, and other harm to themselves and/or others in the course of Services without acts of negligence or other fault by Pinnacle Rehab Center or others.
- I understand and agree that Pinnacle Rehab Center is not a medical service provider, is not staffed with veterinarians, and that the Services are not provided by a licensed veterinarian.
- I hereby agree to accept all liability and to fully release, defend, indemnify and hold harmless the Released Parties for any loss, damage, or other claim (including related attorneys’ fees and costs) that may be sustained by myself, the Client (if not the same person), the serviced horse, the equipment provided for Services, any person within close proximity to the Services equipment, and any other property as a result of the horse occupying the Services equipment and reacting adversely to such occupation, whether caused by negligence or other fault of the Released Parties (other than reckless or intentional wrongdoing). Released Parties for purposes of this Agreement shall include: the owner of the facility where the Services are provided, Pinnacle Rehab Center, Unbridled Equine, Lauri Mason, Katie Hawkins and any of these listed parties’ respective spouse, relatives, heirs, agents, assigns, trusts, trustees, beneficiaries, trainers, employees, working students, volunteers, independent contractors, guests, visitors, members, managers, officers, directors, owners, lessors, lessees, licensors, licensees, or others acting on their behalf (collectively “Released Parties”).
- I agree that this Agreement shall be construed and enforced in accordance with the laws of the State of Arkansas. All disputes relating to the interpretation and enforcement of this Agreement shall be resolved by the state court in Washing County, Arkansas and I submit to the jurisdiction and venue of the Court for such purpose. I agree that this Agreement does not expire, that any and all claims and/or causes of actions surviving the release provisions of this Agreement must be brought within one (1) year of the date accrued, and any surviving claim for personal property Loss is limited to $500.00. The prevailing party shall be entitled to recover its attorneys' fees and costs incurred in enforcing the terms of this Agreement and/or in defending or prosecuting any such claims or causes of action. I agree to waive trial by jury in any action with Released Parties.
- I agree that if any provision of this Agreement is deemed invalid or unenforceable, the remaining provisions shall be valid and enforceable to the fullest extent of the law. This Agreement can only be modified in writing signed by myself and Lauri Mason and/or Katie Hawkins. I certify that I have read this entire Agreement and understand that the signing of this Agreement is a condition of my receiving services for the above listed horse from Pinnacle Rehab Center. I know that I have other therapeutic service providers to choose from, and voluntarily intend on my own behalf and my spouse, relatives, heirs, agents, trustees, beneficiaries, representatives, successors, and assigns, to be bound by the terms and conditions contained herein.
Phone
Address
Horse Registered Name
Breed
Barn Name
Discipline
Horse's injury or surgery
Address
Phone
Gender
As the owner or authorized agent for the owner of the above-described horse, by signing below, I represent and confirm that I have the requisite authority to execute this Agreement and bind myself and the owner of the horse to its terms. I hereby consent to and authorize the performance of the following Services as well as any additional Services I verbally consented to during the Services that may not be listed here:
Current rehab protocol, if any:
Surgery
Age
Dated
Owner Name
