Document 6439140

Please carefully read the following boarding agreement and liability waiver for horse boarding and/or horse
related activity at Affinia Farm before signing.
BOARDING AGREEMENT: The following services shall be provided by Affinia Farm:
PROVIDED:
O Pasture/Turnout (Weather Permitting) O Stall
O Hay & Grain
O Cleaning of stall M, W, F, Sat
O Water
O Feedings twice daily (A.M. & P.M.)
Other/add’l arrangements/notes:
________________________________________________________________________________
FEES PER HORSE:
O
O
O
O
Make checks payable to: ________________________________
Monthly Full-Care board fee due by the 5th of the month
$275.00
th
Late payment (assessed the 6 day of month due)
$5.00 per day per horse
Returned check fee (or current bank fee, whichever is higher)
$25.00
Holding fee for vet or farrier (if necessary, with prior arrangement made) $5.00
Partial months will be prorated. 48 hours notice is required to end this agreement as long as all board
and/or other fees are paid/current.
VACCINATIONS AND WORMING REQUIREMENTS
Boarder is responsible for the following annual immunizations and must be current upon arrival:
Influenza, Eastern & Western Encephalomyelitis, Equine Rhinopneumonitis , West Nile Virus,
Tetanus Toxoid, Strangles (for horses under two years of age), Potomac Horse Fever;
Negative Coggins Test within the last six months (for horses crossing state lines), or 1 yr for in-state horses, and
Venezuelan Encephalomyelitis (for horses arriving from South, Southwest and Western U.S.).
Boarder will ensure horse(s) is/are wormed in concert with Affinia Farm’s de-worming program to allow for
stable control of parasites. Worming will be done according to Veterinary guidelines as to time frame and
appropriate product/type; boarders are to leave used wormer syringe and box with farm management w/ horse
name, & date given. If any boarders have not de-wormed their horses per the schedule, Affinia Farm reserves
the right to administer the wormer and will assess the cost of same to the owner.
BOARDER RESPONSIBILITIES
Halter and lead
Worming
Tack & Equip.
Salt/Trace Mineral Block
Farrier & Arrangements
Grooming/bath supplies
Vet & Arrangements
Meds and/or supplements
LIABILITY
Boarder shall be held monetarily responsible for any property damage. This includes but is not limited to
stalls/run-ins, fencing, arenas, and other facilities caused by their horses(s), dependant(s) or guest(s).
Normal wear and tear will not be considered damage.
INSURANCE
Affinia Farm does not assume responsibility for the loss or damage of any individual’s property stored on the
grounds or for the loss or injury of animals accepted for boarding.
Contract Agreement/Client Signature:
NAME: _________________________________________
HOME PHONE # ______________________
ADDRESS: ______________________________________
CELL PHONE # _______________________
E-MAIL ADDRESS: ______________________________
WORK PHONE# _______________________
HORSE(S) NAME(S)
SEX
BREED
COLOR/MARKINGS
AGE/DOB
Horse 1: __________________________
___
__________
______________________ ___________
Horse 2: __________________________
___
__________
______________________ ___________
Horse 3: __________________________
___
__________
______________________ ___________
Horse 4: __________________________
___
__________
______________________
___________
Horse 5: __________________________
___
__________
______________________
__________
Is there insurance on any of the above listed horse(s)? _____
Insurance Co. information (optional):______________________________________________________
ACTIVITY WAIVER/RELEASE FORM
I am over 18 years of age and acknowledge that Affinia Farm is providing boarding and riding facilities, in
which I wish to participate. I recognize and acknowledge that my participation in such activities and any other
activities which may include equine activities, involve the possibility of inherent risks including, but not limited
to, any of the following:
•
•
•
•
•
The propensity of an equine to behave in ways that may result in injury, death, or loss to persons on or
around the equine;
The unpredictability of an equine’s reaction to sounds, sudden movement, unfamiliar objects, persons, or
other animals;
Hazards, including, but not limited to surface or subsurface conditions;
A collision with another equine, another animal, a person, or an object;
The potential of an equine activity participant to act in a negligent manner that may contribute to injury,
death, or loss to the person of the participant or to the other persons, including, but not limited to, failing
to maintain control over an equine or failing to act within the ability of the participant.
With full knowledge of the above and any other inherent risks which may be associated with equine activities, I
hereby consent to my participation in the above described activities, and I agree to waive any and all claims for
personal injury or property damage of any kind which I, my dependants, or my heirs, personal representative
and next of kin may have or which may arise against Affinia Farm as a result of my participation in such equine
activities, whether or not such injuries or damages result from negligence or legal liability. On behalf of
myself, my dependants, my heirs, personal representative and next of kin, I hereby release and discharge Affinia
Farm, its successors, assigns, affiliates, employees and agents from any and all liabilities claims, lawsuits,
losses, costs, causes of action and damages of any kind originating or in any way arising from my/their
participation in such equine activities.
I hereby declare that the terms of this Boarding Agreement and Activity Waiver/Release have been
completely read, and are fully understood and are voluntarily accepted for the purpose of my
participation in the activities described herein.
____________________________
Signature of adult over 18
____________________________
Signature of adult over 18
________________________________
Printed Name
________________________________
Printed Name
Witnessed by (Affinia Staff Member):______________________________
___________
Date
___________
Date
__________
Date
SHOULD AFFINIA FARM STAFF BE UNABLE TO REACH YOU IN CASE OF A MEDICAL EMERGENCY
INVOLVING YOUR HORSE(S), PLEASE LIST THE TOP MONETARY LIMIT YOU WILL AUTHORIZE
FOR VETERINARY TREATMENT: $______________
IS THERE SOMEONE WE CAN CONTACT WHO IS AUTHORIZED TO MAKE DECISIONS IN YOUR
ABSENCE REGARDING EMERGENCY VETERINARY TREATMENT OF YOUR HORSE(S)? IF YES,
PLEASE LIST INFORMATION BELOW:
___________________
Name
_____________________________________ _______________________
Address
Phone (Home & cell)
BARN RULES
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Close any/all gates or other escape barriers on doors, etc., behind you
Make sure tack room(s) are locked before you leave
Clean up after yourself and your horse in the aisles, arena(s), crossties, and driveways
Aisles are to be kept clear of clutter, personal items, etc. for safety; please use tack room for storage
No smoking anywhere on the property
No dogs permitted on property.
No alcohol intoxication or drugs of abuse on the premises
Turn the lights out when you leave, make sure tack room(s), office, are locked,
No entering another client’s stall or handling, riding, etc., another client’s horse unless express
permission has been given by the owner in writing to management, or unless it is an emergency and no
Affinia staff are on premises, if an emergency contact Affinia Mgr. immediately.
No reckless, dangerous, or grossly inconsiderate riding or other horse handling behavior is permitted;
please be considerate of each other.
Please do not tie your horse to a stall front or any beams/posts in the aisles or arena. Please use a
crosstie area or a tie attached to the inside stall wall.
Do not use anyone else’s tack or equipment without express permission from the owner;
No abuse of any animal on the premises will be tolerated at any time and would be considered grounds
for eviction from the stable;
Barn hours will be from 8am to 10 pm unless special circumstances (illness of horse, prep for show,
etc.) necessitate additional time-please advise barn management in advance if possible;
Although not mandatory, Affinia Farm strongly encourages the wearing of safety helmets when riding,
and proper footwear/boots, especially for minors under 18 years of age;
Please put away any equipment (cones, training aids, jumps, etc.) you used in the arena(s) when
finished.
Boarders may take lessons with their own personal trainer at Affinia Farm-please contact Affinia
manager to work out a schedule for this/use of the facility at a specific date/time, etc.
Affinia Farm wants all of our clients to enjoy their horses in a relaxing, fun atmosphere. We want you to know
that you are important to us, and we wish to create and maintain an environment here that is warm and
welcoming to everyone. Our clients should feel confident that their horses are cared for by our staff in a
professional manner, with kindness and consideration that is to be expected at a quality horse facility.
If you have any questions or concerns whatsoever, please feel free to contact our management staff-we are
happy to be of assistance!