Riders Name
*
First Name
Last Name
Rider's Birthday MM/DD/YYYY
*
MM
DD
YYYY
Rider's Age
*
CHOOSE YOUR TROT N TOTS SESSION(S)
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2024 Trot and Tots Program
(Ages 3 to 6 years)
4-week program fee $220 + HST.
Each class is 1 hour.
*Note - registrations are accepted on a 1st come, 1st serve basis.
Guardian Name (1)*
*
First Name
Last Name
Guardian (1)'s relationship to rider
*
Guardian (1) Main phone number
*
(###)
###
####
Type of main phone
*
CHOOSE ONE
CELL
HOME
WORK
Guardian (1) 2nd phone number
(###)
###
####
Type of phone for Guardian 1
CHOOSE ONE
CELL
HOME
WORK
Guardian (2) name
First Name
Last Name
Guardian (2)'s relationship to rider
Guardian (2) Main phone
*
(###)
###
####
Type of phone:
CHOOSE ONE
CELL
HOME
WORK
Guardian (2) 2nd phone
(###)
###
####
Type of phone:
CHOOSE ONE
CELL
HOME
WORK
Rider's mailing address
*
City
*
Postal Code
*
Alternative Emergency Contact Name
*
First Name
Last Name
Relationship to rider
*
Phone Number
*
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
PERMISSION
*
I desire my child to participate in "Trot and Tots" Mini Horsemanship Program (operated by Sarah C. Parks) for a 4 week session, including all activities unless I advise otherwise in writing. The price of the program is $220 (Plus HST) for a 4 week session.
ABSENCE
*
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.
HOW TO PREPARE FOR OUR RIDING PROGRAMS
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Light Snack and Lots to Drink
We ask parents please bring a small snack for our picnic style snack time!
Sun Block and Bug Spray
We will be outdoors in the sun, so bring what you need to protect you and your child.
Footwear and Clothing
Riders & Parents: Absolutely no open-toed shoes are to be worn at any time!
For our riders, boots or shoes with a heel are recommended. Rain boots or runners are acceptable. Long pants or sweat pants are acceptable to wear but we do not advise wearing nylon or slippery pants. In our warmer months, long shorts, capris, pants or sweat pants are acceptable to wear or pull over shorts for riding.Dress in layers and be prepared for temperature changes. Bring a sweater or jacket as mornings are cooler.
Helmets
We will supply riding helmets, however riders are encouraged to bring their own if they have them.
CONSENT AND WAIVER OF LIABILITY
*
To SARAH PARKS HORSEMANSHIP, their directors, employees, officers, volunteers, business operators, and site property owners. (all of them collectively called the HOST)
Initial (check box) each item below After Reading and Understanding the item:
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.
I Understand there are Inherent 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.
I Acknowledge that the Inherent “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 for the Inherent “RISKS”
*
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 for safety of the infant
*
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.
The 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.
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”.
Guardian Signature
Guardian name
First Name
Last Name
Guardian's Birthday (dd/mm/yyyy)
*
MM
DD
YYYY
Guardian's Address
*
