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.

    Release and Waiver of Liability and Indemnity Agreement (To be signed by persons 18 years of age or older)

    In consideration of being permitted by Instill Harmony LLC to participate in equestrian activities, the undersigned hereby releases, waives and discharges Instill Harmony LLC, Lauren Harmon, their past, present and future agents, officers, members, managers, insurers, independent contractors, and employees (hereinafter referred to collectively as the “Releasee”) from all liability to the undersigned, personal representatives, assigns, heirs and next of kin for any and all loss or damage and any claim or demands therefore on account of injury to the undersigned person, the person’s horse, any type of property damage or resulting in the death of the undersigned, whether caused by the negligence of Releasee or otherwise, incident to or while the undersigned is engaging in any equine activity, including but not limited to horse shows, horse training or teaching activities, boarding horses riding, driving, being a passenger upon an equine, whether mounted or un-mounted, assisting a person participating in an equine activity or show management, assisting in the medical treatment of a horse, inspecting or evaluating a horse or standing in proximity to any horse and/or while on Releasee’s premises or in session with Releasee.

    The undersigned expressly acknowledges and agrees the activities undertaken by the undersigned as contemplated above are inherently dangerous and involve risk of serious bodily injury and/or death, and/or property damage. The undersigned hereby agrees to indemnify and save and hold harmless Releasee from any loss, liability, damage or cost they may incur due to the inherently dangerous activity described hereinabove, whether caused by the negligence of Releasee or otherwise. The undersigned hereby assumes full responsibility for and risk of bodily injury, death or property damage including any damage to an animal, due to negligence of Releasee, or otherwise while participating in the inherently dangerous activities described hereinabove.

    The undersigned further expressly agrees the foregoing Release, Waiver and Indemnity Agreement is intended to be broader and more inclusive than the limitations set forth in CRS section 13-21-119 and to be as broad and as inclusive as permitted by the laws of the State of Colorado, and if any portion hereof is held invalid, then the remainder of the Release, Waiver and Indemnity Agreement shall, not withstanding, continue in full force and effect.

    The undersigned is eighteen (18) years of age or older, has read, understands and voluntarily agrees to all terms of this Release and Waiver of Liability and Indemnity Agreement, and expressly acknowledges no insurance coverage of any kind is to be provided, included or guaranteed by Releasee. The undersigned expressly acknowledges no oral representations, statements or inducements apart from the foregoing written agreement have been made.

    WARNING: Under Colorado Law, an equine professional is not liable for an injury to or death of a participant in equine activities resulting from the inherent risk of equine activities, pursuant to CRS section 13-21-119.

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