Phancy Pharm Horse Camp Registration Sheet

 

Name:      ____________________________________________

Address:  ____________________________________________

                  ____________________________________________

Age:            ______

Experience Level (circle one):

          First time around horses

          Been around horses, but have never ridden

          Have sat on a horse, but no lessons

          Have taken a few lessons

          Comfortable at the walk and trot/jog

          Comfortable at the walk, trot/jog and canter/lope

 

I would like to sign up for the following camps:

HC 1 – June 8 – 12 – 9am – 12

HC 1 – June 8 – 12 – 1pm – 4pm

HC II – June 15-19 – 9am – 12

HC II – June 15-19 – 1pm – 4pm

 

Cost of 1 camp - $170                                           Cost of 2 camps - $300

All camp participants MUST have a signed release before they will be allowed to take part in camp activities.

 

Phancy Pharm Release from Liability

 

This release gives notice to the participant, or parent or guardian, of the risks of engaging in equine activities, including (i) the propensity of an equine to behave in dangerous ways that may result in injury to the participant, (ii) the inability to predict an equine's reaction to sound, movements, objects, persons, or animals, and (iii) the hazards of surface or subsurface conditions.

 

I the undersigned, for myself, or as parent or legal guardian or representative of the below noted child(ren) or persons, and those who I may otherwise have in my care, hereby release Stokes Landing Sport Horses (dba Phancy Pharm), its owners, employees and agents from any and all liability for any damages that arise from the activity to be participated in by the persons/child(ren)/persons so indicated, which may be an ultra hazardous activity.  In granting this release I understand that I, or my child(ren)/persons may not participate in the activity without the permission of a parent or legal guardian, and release and authorize Phancy Pharm to control the activity to their sole discretion, and that in doing so they may cease the activity at any time or bar any child(ren)/person from further participation at any time, or take such reasonable action is necessary to ensure the safety of all participants.  I further authorize medical treatment as necessary for which I am responsible for any costs thereof.  I agree that riding a horse may include hazardous and unknown actions of the horse.  I agree to protect, defend and indemnify the PHANCY PHARM from any claim that I, my children or ward, my heirs, or assigns may make against the PHANCY PHARM.

 

Under the Equine Activity Liability Act, each participant who engages in an equine activity expressly assumes the risks of engaging in and legal responsibility for injury, loss, or damage to person or property resulting from the risk of equine activities.

 

OWNER(S)/RIDER(S):         ________________________________

                                                ________________________________

                                                ________________________________

 

 

Signed by:               _________________________              ____________

                                Signature                                                 Date

 

Phone Number:                       ___________________________________

 

Email Address:                        ___________________________________

 

HAVE YOU INFORMED PHANCY PHARM OF ANY MEDICAL OR PHYSICAL CONDITION(S) THAT  MIGHT ENDANGER OR IMPEDE YOU DURING YOUR PARTICIPATION IN THIS SPORT?  CIRCLE ONE OF THE THREE ANSWERS BELOW.

 

                                YES                                                        NO                                          NO CONDITIONS

 

Emergency Phone Numbers:                   ___________________________________

                                                                ___________________________________

                                                                ___________________________________

 

Alternate Contact(s):                               ___________________________________

                                                                ___________________________________