Riders Name
*
First Name
Last Name
Riders date of birth
*
MM
DD
YYYY
Riders age
*
Rider's mailing address:
*
City:
*
Postal Code:
*
Main Phone
*
(###)
###
####
Type of phone
*
CHOOSE ONE
Home
Work
Cell
Second Phone
*
(###)
###
####
Type of phone:
*
CHOOSE ONE
Home
Work
Cell
Guardian (1) name
*
First Name
Last Name
Guardian (1)'s relationship to rider
*
Guardian (1) Main phone
*
(###)
###
####
Type of phone
*
CHOOSE ONE
Home
Work
Cell
Guardian (1) 2nd phone
(###)
###
####
Type of phone:
CHOOSE ONE
Home
Work
Cell
Guardian (2) name
First Name
Last Name
Guardian (2)'s relationship to rider
Guardian (2) Main phone
(###)
###
####
Type of phone:
CHOOSE ONE
Home
Work
Cell
Guardian (2) 2nd phone
(###)
###
####
Type of phone:
CHOOSE ONE
Home
Work
Cell
Alternative Person for drop off/pick up name
Alternative Person's relationship to rider
Alternative Person's Main phone
(###)
###
####
Type of phone:
CHOOSE ONE
Work
Home
Cell
Alternative Emergency Contact Name
*
Relationship to rider
*
Phone Number
(###)
###
####
Type of phone
*
CHOOSE ONE
Work
Home
Cell
Does your child have any health problems/medical conditions/allergies/special needs?*
*
CHOOSE ONE
Yes
No
If yes, please list allergies (give details ex. dust, food, insects, etc.), medications, limiting factors, medical concerns, treatment required, special needs:
Does your child carry an EPI-pen?
*
CHOOSE ONE
Yes
No
OHIP Card Number
What is your child's riding experience?
*
CHOOSE ONE
Beginner
Intermediate
Advanced
Please describe your child's riding experience
PERMISSION
*
PERMISSION
I desire my child to participate in the Spring Break Camp. The price of the camp program week is $423.75 (HST included) I agree that if my child fails to complete the program, the fee will not be refunded.
Vacation
*
I have notified the Coordinator of any pre-planned vacation. In the event that my child cannot attend the program and an alternative date cannot be arranged I am aware that my fee will not be reimbursed.
PREPARE FOR OUR RIDING PROGRAMS
*
Snacks & Drinks
We will be breaking in between activities, bring snacks and plenty to drink to refuel and stay hydrated.
Dress for the Weather
We will be outdoors in the elements so bring what you need to stay warm including insulated gloves, (2 pairs) insulated / waterproof winter boots, a warm winter coat, snow pants, and lots of warm layers.
We will supply riding helmets and grooming kits. (Riders are encouraged to bring their own if they have them.)
PARENT/LEGAL GUARDIAN
*
1. I am the Parent and/or Legal Guardian of the infant Participant named above and am executing this form on behalf of the infant Participant in my capacity as parent and/or guardian and with the intent that this form be binding on myself and infant Participant for all legal purposes.
DANGERS, HAZARDS and RISKS,
*
2. I Understand there are Inherent DANGERS, HAZARDS and RISKS, (collectively called RISKS) associated with Equine Activities and injuries resulting from these “RISKS” are a common occurrence.
“RISKS” of Equine Activities
*
3.I Acknowledge that the Inherent “RISKS” of Equine Activities mean those DANGEROUS conditions which are an integral part of Equine Activities, including but not limited to:
• The propensity of any equine to behave in ways that might result in injury, harm or death to persons on or around them and to potentially collide with, bite or kick other animals, people, or objects.
• The unpredictability of an equine’s reaction to such things as sounds, sudden movement, tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface objects.
• The potential for other participant (s) to act in a negligent manner that might contribute to injury to themselves or others, such as failing to act within their ability or to maintain control over an equine. * the potential of natural or man-made hazards being present that can cause me harm, including communicable disease*
I Freely Accept and Fully Assume All Responsibility
*
4. I Freely Accept and Fully Assume All Responsibility for the Inherent “RISKS” and the possibility of personal injury, death, property damage or loss which might result from the infant being a Participant.
Sole Responsibility
*
5. I Acknowledge that it remains my Sole Responsibility for the safety of the infant Participant and for the infant to Participate within his/her own limits. Should it be determined that my child cannot keep up to the equine activity classes or is at risk or puts others at risk, a worker will be provided by the camp and I agree to pay an additional fee for this service. Sarah C Parks reserves the right to withdraw a participant for safety or behavioral reasons, and there will be no refunds for the days attended.
HOST
*
6. In addition to consideration given for the infant to Participate in Equine Activity, I and my heirs, executors, administrators and assigns (collectively called my “Legal Representatives”) agree:
• To Waive All Claims that I or the infant Participant might have against the “HOST”; and
• To Release the “HOST” from Any and All Liability for any loss, damages, injury, or expense that I, the infant Participant or our “Legal Representatives” might suffer as a result of the infant’s Participation due to any cause including any NEGLIGENCE ON THE PART OF THE “HOST”; and
• To HOLD HARMLESS AND INDEMNIFY THE “HOST” from any and all liability for property damage or personal injury to the infant Participant or to any third party which might result from the infant’s Participation.
Participant Termination
*
Sarah Parks Horsemanship is committed to providing all participants (Clients) in our programs with a positive experience. By purchasing our services, the participant agrees that Sarah Parks Horsemanship may, at its sole discretion, terminate this Agreement, and limit, suspend, or terminate Client’s participation in our programs without refund if Client becomes disruptive or endangers Sarah Parks Horsemanship employees, volunteers or participants, Client fails to follow the Program guidelines, is difficult to work with, impairs the participation of the other participants in the Program or upon violation of the terms as determined by Sarah Parks Horsemanship. Client will still be liable to pay the full amount owing for services rendered.
DO NOT SIGN until you understand ALL items above
*
Before checking the "I agree" box on this form, I read it (as indicated by my checked boxes above) and I stated I understand it. I know that checking the "I agree" box on this form, waives certain legal rights I and/or the infant Participant and/or our “Legal Representatives” might have against the “HOST”.
Rider Participant signature
Guardian Signature:
*
Guardian name
*
First Name
Last Name
Guardian's Birthday* (dd/mm/yyyy)
*
MM
DD
YYYY
Guardian's Address
*
