Embodied Equestrian Consent Form

  • APPLICATION AND CONSENT - Embodied Equestrian

    Rolfing® structural integration For Horse And Rider

    I hereby apply for a standard series of processing in Rolfing (structural integration) for my horse and myself while riding.

    I fully understand the purpose of Rolfing is to balance and align the physical body so that it is supported and maintained by gravity in three-dimensional space. This is done through direct manipulation and education so that greater economy and freedom of body-movement are achieved.

    I understand Rolfing is not involved with the treatment of disease of any kind, nor does it substitute for medical diagnosis or treatment when such attention is needed.

    The Rolfer does not treat, prescribe or diagnose an illness, disease, or any other physical or mental disorder of the horse and rider. Nothing said or done by a Rolfer should be misconstrued to be such.

    I understand it is necessary for the Rolfer to touch my horse’s body and my body in order to assist us in establishing balance and alignment in our bodies.

    I give Lauren Harmon my permission and consent to do all those things necessary in helping my horse and myself establish balance and alignment, including, but not limited to touching my horse’s body and myself. I give the Rolfer full privilege and license to work on my horse and on myself in such a way as to restore and establish balance and alignment therein.

    Furthermore, I understand that any relief of physical or emotional symptoms is coincidental in the organization of the total horse and rider and is not the basic goal of Rolfing.

    I understand the potential dangers that I could incur in mounting, riding, walking, boarding, feeding said horse; including, but not limited to, any interactions with other horses. Understanding those risks I hereby release that Instill Harmony LLC, its officers, directors, shareholders, employees and anyone else directly or indirectly connected with Instill Harmony LLC from any liability whatsoever in the event of injury or damage of any nature (or perhaps even death) to me or anyone else caused by or incidental to my electing to mount and ride a horse owned or operated by Instill Harmony LLC.

    I understand and recognize and warrant that this Release and Hold Harmless Agreement, is being voluntarily and intentionally signed and agreed to, and that in signing this Release and Hold Harmless Agreement I know and understand that this Release and Hold Harmless Agreement may further limit the liability of equine professionals to include any activity, whatsoever, involving an equine, including death, personal injury and/or damage to property.

    I recognize and agree that I know which equine professional(s) I will be working with, and acknowledge that I agree said equine professional(s) has/have made reasonable and prudent efforts to determine my ability to engage in the equine activity, and has/have sufficient knowledge of my equine and horseback riding skills as to relieve, release and hold harmless said equine professional(s) from any continuing duty to monitor my equine activities.

    I further voluntarily agree and warrant to Release and Hold Harmless this (these) equine professional(s) from any liability whatsoever, including, but not limited to, any incident caused by or related to said equine professional’s (s’) negligence, relating to injuries known, unknown, or otherwise not herein disclosed; including, but not limited to, injuries, death or property damage from: mounting; riding; dismounting; walking; grooming; feeding; use of horse barn, paddock, trails or horse ring, in any capacity; falling off horse whether horse is bucking, flipping, spooked; or my failure to understand any equine professional’s directions relating to my riding or otherwise use and control, or lack thereof, of my horse or the horse I have been assigned to.

  • By signing and submitting this document, you consent to Lauren Harmon working with your horse(s) and the terms on this form.