Dance, Ballroom, and Horseback Riding Lessons
Registration form for Take the Lead Academy LLC
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  • Please Select which class(es) the above student will be attending:
  • Method of Payment

    I hereby authorize Take the Lead Academy, LLC to charge my bank/credit card account on the first day of each month. Charges will be ongoing unless I withdraw according to the school’s withdrawal policy. Withdrawals must occur within the first 7 days of the month in order to stop the following month’s draft. Withdrawal forms will be provided and must be completed in person. Students paying on a cash basis will need to abide by the same withdrawal policy as those on auto draft.
  • Routing Number
  • Account Number
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  • $ .
  • Liability Release

  • 1. Rider is responsible for full and complete insurance coverage on his/her horse, personal property, and himself/herself.

    2. Rider is aware of the following Arkansas law which reads, "WARNING: UNDER ARKANSAS LAW, an equine activity sponsor is not liable for an injury to, or death of, a participant in equine activities resulting from the inherent risk of equine activities."

    3. Rider agrees to assume any and all risks involved in or arising from rider’s use of or presence upon Manager/Instructor’s property and facilities or current landowner’s property and facilities including, without limitation but not limited to: the risks of death, bodily injury, property damage, falls, kicks, bites, collisions with vehicles, horses or stationary objects, fire or explosion, the unavailability of emergency medical care, and/or the negligence and/or deliberate act of another person.

    4. Rider agrees to hold Manager/Instructor and all successors, assigns, subsidiaries, franchises, affiliates, officers, directors, employees and agents completely harmless and not liable, and releases them from all liability whatsoever and AGREES NOT TO SUE them on account of or in connection with any claims, causes of action, injuries, damages, costs or expenses arising out of Rider’s use of or presence upon Manager/Instructor’s property and facilities or current landowner’s property and facilities, including without limitation, those based on death, bodily injury, property damage, including consequential damages, except if the damages are caused by the direct, willful and wanton gross negligence of the Manager/Instructor or current property owner.

    5. Rider agrees to waive the protection afforded by any statue or law in any jurisdiction (e.g., California Civil code 1542) whose purpose, substance and/or effect is to provide that a general release shall not extend to claims, material or otherwise, which the person giving the release does not know or suspect to exist at the time of executing the release.

    6. Rider agrees to indemnify and defend Manager/Instructor and/or current property landowner against, and hold harmless from, any and all claims, causes of action, damages, judgments, costs or expenses, including attorney’s fees, which in any way arises from Rider’s use of or presence upon the Manager/Instructor’s property and facilities or current property landowner’s property and facilities, or any properties and facilities which are made available by the current property landowner for use by the Manager/Instructor.

    7. Rider agrees to abide by all of the Manager/Instructor’s rules and regulations, and Rider is responsible for using protective gear, i.e., hard hat, hard sole shoes or boots. If Rider chooses not to wear a hard hat and/or hard sole shoes or boots, the Manager/Instructor and/or current property landowner will be held harmless from any and all claims that may result due to the Rider’s decision not to wear protective gear as recommended by the Manager/Instructor.

    8. Rider agrees to pay designated costs for riding instruction and agrees to pay beforehand for lesson(s)/class(es) and if Rider becomes late in payment, Rider will be assessed a late charge per lesson/class. If Rider’s account becomes more than 30 days delinquent, Rider agrees to pay all costs (collection fees, court fees, lawyer fees) to collect owed monies. In the event of a cancellation, Rider agrees to provide 24-hour notice. Rider will be charged a fee equal to the lesson/class fee, but will be allowed two make-up lessons in a calendar year. A doctor’s note must accompany cancellation.

    9. If Rider is using Rider’s horse, the horse shall be free from infection, contagious or transmissible diseases. Manager/Instructor reserves the right to refuse horse if not in proper health or if deemed dangerous or undesirable. Rider is responsible for all damages caused by Rider’s horse.

    10. Rider consents to and authorizes the use and reproduction by Take the Lead Academy of any and all photographs and any other audio/visual materials taken of him/her for promotion and advertising material, educational activities, exhibitions or for any other use for the benefit of the Academy.

    This contract is non-assignable and non-transferable and is made and entered into the State of Arkansas, and shall be enforced and interpreted under the laws of this state. Should any clause be in conflict with State Law, then that clause is null and void. When the Manager/Instructor and Rider (and Rider’s parent or guardian if Rider is a minor) sign this contract, it will then be binding on both parties, subject to the above terms and conditions.
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