2019 Trot and Tots Mini Horsemanship Programs
(Ages 3 to 6 years) 3 week program fee $160.00 plus HST
CHOOSE YOUR TROT N TOTS SESSION(S) FOR THE 2019 RIDING SEASON:
May Session 10-11:30 am (Saturday, May 11, 18, 25)-limited spots availableJune Session 10-11:30 am ( Saturday, June 8, 15, 22)-limited spots availableJuly Session 10:30-12:00 pm (Wednesday, July 17, 24, 31)-limited spots availableAugust Session 10:30-12:00 pm (Wednesday, August 7, 14 ,21 )-limited spots availableSeptember Session 10-11:30 (Saturday, September 7, 14, 21)-limited spots availableOctober Session 10-11:30 am (Saturday, October 5, 12, 19 )-limited spots available
Rider First Name* Rider Last Name*
Please provide an e-mail address so that we can send you updates, newsletters and other information. All information is kept strictly confidential and we will not share your e-mail address with any individual or organization.
Guardian (1) name* Guardian (1)'s relationship to rider*
Guardian (1) Main phone* Type of phone*:---CELLHOMEWORK
Guardian (1) 2nd phone Type of phone:---CELLHOMEWORK
Guardian (2) name Guardian (2)'s relationship to rider
Guardian (2) Main phone Type of phone:---CELLHOMEWORK
Guardian (2) 2nd phone Type of phone:---CELLHOMEWORK
Rider's Birthday MM/DD/YYYY * Rider's Age*
Rider's mailing address:* City:*
Alternative Emergency Contact Name* Relationship to rider*
Does your child have any health problems/medical conditions/allergies/special needs?*
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?---YESNO
OHIP Card Number
To match your child with his/her ideal horse or pony, please provide his/her approximate:*
Height (ex. 5'3") Weight in Pounds
PLEASE READ AND AGREE TO THE FOLLOWING 2 SECTIONS BEFORE SUBMITTING YOUR REGISTRATION FORM:
I desire my child to participate in "Trot and Tots" Mini Horsemanship Program (operated by Sarah C. Parks) for a 3 week session, including all activities unless I advise otherwise in writing. The price of the program is $180.80 (HST included) for a 3 week session.
Sarah Parks Horsemanship may periodically photograph participants during sessions for the purpose of sharing photographs through photo albums, electronic media, or for the purposes of promotional material and/or public relations. Please indicate your permission to publish photographs for any of the above purposes by checking one of the following:
Please choose one of the following:
---I agree to allow Sarah Parks Horsemanship to photograph and use images of me and/or my child.I will not allow photo’s to be taken of me and/or my child. I understand it is my responsibility to ensure me/and or my child are not involved at the time pictures are taken.
I understand that registrations are received on a first come, first serve basis and that payment in full is required to reserve my spot in the program. Payment can be received by etransfer, cash or cheque. (sorry - no credit cards or debit) * Please make cheques payable to Sarah Parks and mail to: 7150 County Rd 20, RR#5, Amherstburg, On, N9V OC8.
I am sending the required full payment by (please choose payment method):*---E-TRANSFERCHEQUE BY MAILCASH OR CHEQUE to be dropped off at the Ranch Office (please call ahead to coordinate a time)
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
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.
We will supply riding helmets, however riders are encouraged to bring their own if they have them.
SECTION TWO: 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.
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.
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.
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.
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.
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.
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”.
Do Not Sign until you Understand All Items Above.
Rider Participant Signature:
Guardian name* Guardian's Birthday* (dd/mm/yyyy)