Apple Tree Farm Information Form
Student Name: ______
Date of Birth: ______E-mail: ______
Address: ______
Home #: ______Cell #: ______
Father’s Name: ______
Work # ______
Home#: ______Cell #______
Email: ______
Mother’s Name: ______
Work# ______
Home # ______Cell # ______
Email: ______
Physician Name: ______
Address: ______
Group#: ______Telephone #: ______
Insurance Co: ______Policy #: ______
In case of emergency, notify:______Phone# ______
Does the Rider have any medical conditions or learning disabilities: ______
Please list all medications that the Rider is currently taking:
______
Please briefly describe riding experience: ______
Medical Release
In the case that I am unable to be reached, I hereby agree that Alison Eastman, Ann Grenier, and/or Apple Tree Farm staff in conjunction with medical personnel shall make medical decisions on my behalf, in my absence, while my child is participating in Apple Tree Farm activities.
Parents Signature:______Date ______
Apple Tree Farm General Release of Liability, Hold Harmless and Indemnity Agreement for Equine and Equine Related Activities
Rider’s Name: ______
Address: ______
Telephone: ______
If Rider is a minor, parent or guardian information:
Name: ______
Address: ______
Telephone: ______
This agreement is made between Alison Eastman d/b/a Apple Tree Farm, Shawn Lawler, Lucinda Eastman, Hollis Horse Farm, LLC, and/or any additional landowners where such equine activities may take place, owners of any horses that may be used at Apple Tree Farm by Rider in lessons or for events/shows, and Rider and Rider’s parents or guardian, if Rider is a minor. In consideration of the use and enjoyment of Apple Tree Farm’s property, property of Lucinda Eastman, Hollis Horse Farm, LLC, and/or additional landowners where such equine activities may take place and the services, training, skills, animals or facilities, today and for all future dates, whether for fee or not, Rider and Rider’s parent(s) or guardian(s) on behalf of Rider each, and their heirs, and assigns hereby release, hold harmless and indemnify Alison Eastman d/b/a Apple Tree Farm, Lucinda Eastman, Shawn Lawler, Hollis Horse Farm, LLC, owners of any horses that may be used by Rider in lessons or for other equine related activities, Apple Tree Farm agents, employees and assigns, for any and all activity in any way related to equine activities, including but not limited to any activity for which the Rider and/or parents may be present on Apple Tree Farm property or property owned by Lucinda Eastman, Alison Eastman, Shawn Lawler and Hollis Horse Farm, LLC , including as a spectator.
Rider and Rider’s parent(s) or guardian(s) on behalf of Rider agree as follows:
1. If only one parent signs this agreement, that parent represents that they have the authority to sign on behalf of and thereby bind both parents.
2. Rider and Parents agree to abide by all rules and regulations of Apple Tree Farm.
3. Rider and Parents agree to carry insurance on their personal property and themselves.
4. Rider and Parents understand and agree that horseback riding in all respects, including but not limited to riding on the flat in a ring, jumping fences and other obstacles, slippery and rough footing, etc. can be a very dangerous activity, and they wish nevertheless to participate.
5. Rider and Parents agree that any work done by them without monetary compensation in and around Apple Tree Farm does not make them employees or agents of Apple Tree Farm.
6. Rider and Parents recognize that they are voluntarily participating in equine activities at Apple Tree Farm. Rider and Parents assume and accept any and all risks involved in or in any way arising from their use of, or presence upon, the property of Apple Tree Farm, Lucinda Eastman, Alison Eastman, Shawn Lawler, Hollis Horse Farm, LLC, and/or additional landowners where Apple Tree Farm equine activities may take place, including but not limited to bodily injury, death, property damage, and the unavailability of emergency medical care, or any other loss or damage, even if the method of injury or loss
Updated 12/22/13
or the nature or extent thereof are not contemplated at the time of signing of this agreement.
7. Rider and Parents acknowledge that by signing this agreement Alison Eastman d/b/a Apple Tree Farm’s legal rights will extend to those found under RSA 508:19 and beyond to the greatest extent permitted by New Hampshire and South Carolina law.
8. Rider and Parents understand and agree that under New Hampshire and South Carolina law, a participant in equine activities assumes the risk of any injury, harm, damage, or death, and any legal responsibility that may occur to participants from the inherent risks associated with equine activities and further agrees that PURSUANT TO R.S.A. 508:19 EQUINE PROFESSIONALS ARE NOT LIABLE FOR DAMAGES RESULTING FROM INHERENT RISKS ASSOCIATED WITH EQUINE ACTIVITIES.
9. By signing this document, Rider and Parents agree to not bring any claim of any kind whatsoever against Alison Eastman d/b/a Apple Tree Farm, Shawn Lawler, Lucinda Eastman, Hollis Horse Farm, LLC, owners of any horses that may be used by Rider in lessons or for other equine related activities done at or under the auspices of Apple Tree Farm, Apple Tree Farm agents, employees and assigns, for any and all activity in any way related to equine activities, including but not limited to any activity for which the Rider and/or parents may be present on Alison Eastman d/b/a Apple Tree Farm property, Shawn Lawler, Lucinda Eastman, and/or Hollis Horse Farm, LLC, premises, including as a spectator. In addition, Rider and Parents agree to indemnify and hold harmless Alison Eastman d/b/a Apple Tree Farm, Shawn Lawler, Lucinda Eastman,, Hollis Horse Farm, LLC, and the owner of any horse that may used by Apple Tree Farm for lessons or other equine related activities, from any claims that may be brought, and that such indemnity will extend to any amounts for which the aforementioned parties may be liable, including attorney fees, costs and judgments.
10. NOTWITHSTANDING ANYTHING CONTAINED WITHIN, RIDER AND PARENTS UNDERSTAND THAT THIS AGREEMENT IS INTENDED TO AND DOES EXTEND TO CLAIMS OF ANY KIND, INCLUDING THE NEGLIGNECE OF ALISON EASTMAN D/B/A APPLE TREE FARM, SHAWN LAWLER, LUCINDA EASTMAN, HOLLIS HORSE FARM, LLC, AND THE OWNERS OF ANY HORSE THAT MAY BE USED BY APPLE TREE FARM FOR LESSONS OR OTHER EQUINE ACTIVITIES, APPLE TREE FARM AGENTS, EMPLOYEES, WHETHER ALLEGEDLY DUE TO THEIR ACTIONS OR THE ACTIONS OF NEGLIGENCE OF THIRD PARTIES. BY SIGNING THIS AGREEMENT, RIDER AND PARENTS UNDERSTAND THAT ALISON EASTMAN D/B/A APPLE TREE FARM, SHAWN LAWLER, LUCINDA EASTMAN, HOLLIS HORSE FARM, LLC, AND THE OWNERS OF ANY HORSE THAT MAY BE USED BY APPLE TREE FARM FOR LESSONS OR OTHER EQUINE ACTIVITIES, APPLE TREE FARM AGENTS, EMPLOYEES, WILL NOT BE RESPONSIBLE FOR THE CONSEQUENCES OF THEIR OWN NEGLIGENCE.
11. This agreement constitutes a contract made and entered into in the State of New Hampshire,and the State of South Carolina and shall be enforced and interpreted under the laws of this State. Should any clause herein be declared invalid by a New Hampshire or South Carolina court, all other clauses shall remain in full force and effect.
Rider: ______Date: ______
Rider’s parents or Guardian(s) if rider is a minor: Updated 12/22/13
APPLE TREE FARM RIDING LESSON RATES AND POLICIES
Effective Jan. 1, 2014
Monthly Rates (pay for a month of lessons first week of month):
Group Lesson (2 or more students) $165/month
In order to secure a permanent time slot you need to pay by the month.
Weekly Rates (pay for each lesson individually):
Private Lesson $55.00
Private ½ hour (7 and under) $32.00
For weekly rates, payment for each lesson is due at the time of the lesson. If payment is missed at one lesson, payment for both lessons will be due at the time of the second lesson. If payment is not made before the second lesson, the rider will not be allowed to participate in the lesson.
For monthly rates, payment for the entire month is due at the time of the month’s first lesson (the lesson that fall during the first week of the month). In order to secure a set weekly lesson time you need to pay for that time slot.
If a lesson is cancelled due to inclement weather, or illness, then the student will take a makeup at a different time than their regularly scheduled lesson. We ask for a minimum of 24 hours notice when canceling. Makeup lessons must be taken within 60 days of missed lessons. It is the student’s responsibility to call to schedule makeups. You may not apply your makeup lesson as credit in the next month, you must pay full fee for the month.
*Cancellation Policy - We require a minimum of 24 hours notice of cancellation or you will be charged for that lesson and no makeup will be given.
**Due to Apple Tree Farm’s popularity, we often have a waiting list for new students. We are operating at full capacity this year and we want to keep our groups limited in size in order to maintain the quality of our instruction. This will force us to strictly uphold our payment policy and the 24-hour cancellation policy; we can no longer be as lenient about this as we have been in the past due to the limited time slots available for makeup lessons. We hope you will understand, and help us keep Apple Tree Farm a fun and safe place at which to ride.
Once you have read this entire notice, please sign below, keep one copy of the Rates and Policy schedule, and return the signed copy to Alison.
______
Parent/Student signature
______
Date