Vertical Vibration Machine

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Tel: (509) 496 0002

Equine Vertical Vibration Session Liability Release Form

Owners Full Name

Email

Phone

Horse's Name

Horse's Age

Reason for Visit

Horse Sex *

Mare

Gelding

Stallion

I understand and am ok with 24/7 survailence within the Wellness Room

I promise to be kind a coutious to others

I promise to clean up after myself

I promise to do my best to look after the equipment i am using (Virtical Vibration Machine). I may be held liable for any damages obtain on the facility at my cause.

I understand that my assigned time slot is the only time i have to use the Vertical Vibration Machine, then i must vacate the room

I understand that i do not have access to the facilities, out side of the Wellness Room, of Mountain View, unless i pay the faclility haul in fee, located near the restroom.

I declare that my horse has not had a fever within the last 5 days, and is up to date on required shots.

I declare that the info I’ve provided is accurate & complete. I hereby state that I am at least 18 years of age and have read, understand and agree to this Release Statement, that it is an informed release and that I intend to be legally bound by it. I understand the information below is intended for my safety and that of my horse(s). No one has made any representations or claims to me of any treatment or cure of any disease or condition; or any promise of any specific or general results of any kind. I release from all general, medical and any other liability or claims of any kind, on the facility, products, services, employees. vendors and manufactuers.

Enter full name as a forme of signature

Thanks, you are good to go!

Email: info@surgeequine.com

Tel: 509 496 0002 (Text is OK)

CONTACT

SURGE Equine Therapies - Consulting, Sales & Services LLC

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