EMERALD STABLES LLC

Rider Emergency Contact and Consent to Emergency Medical Treatment Form

Rider's Information:

Emergency Contact Information:

1. Primary Emergency Contact

2. Secondary Emergency Contact:

Medical Information:

- Primary Care Physician:

Consent to Emergency Medical Treatment:

In the event of an accident or medical emergency while I,

am participating in activities at Emerald Stables LLC, I hereby give consent to Emerald Stables LLC, its staff, and representatives to act in my best interest and authorize them to:

1. Seek emergency medical attention and treatment for me.

2. Contact the listed emergency contacts.

3. Arrange for the transportation of myself to a medical facility for care, if necessary.

4. Share the above-provided medical information with any emergency medical personnel.

I understand that Emerald Stables LLC, its owners, managers, employees, and representatives are not liable for any costs associated with emergency medical treatment or transportation. I agree to assume full responsibility for all medical expenses incurred.

I also understand that Emerald Stables LLC is not responsible for any outcome or medical decision made by emergency personnel or medical providers.

Consent and Acknowledgment:

By signing below, I acknowledge that I have read and fully understand the terms of this form, and I provide consent as outlined above.

Emergency Contact Acknowledgment:

I acknowledge that I have been listed as an emergency contact for

and agree to be contacted in the event of a medical emergency.