Sabill’s Summer Riding Program
750 Southford Road
Southbury, Connecticut 06488
Student Name:______
Student D.O.B.:______
Horse experience (if any):
Parent / Guardian Name:______
Parent/Guardian Home Phone Number:______
Parent/Guardian Cell Phone Number:______
E-Mail Address:______
Total Number of Sessions:______
I have included (Please circle one): DepositPayment in Full
*Must include a $150 Deposit per child, per week *
______I have read and filled out the Student Registration Form and the Hold Harmless Form (please check).
Please check next to each week you wish to sign up for.
_____ June 25th – June 29th_____ July 30th - August 3rd
_____ July 2nd - July 6th_____ August 6th - August 10th
This is a four day week due to the holiday.
Hours for this week ONLY will be 9:00 am to 2:00 pm)
_____ July 9th - July 13th_____ August 13th - August 17th
_____ July 16th- July 20th _____ August 20th - August 24th
_____ July 23rd - July 27th
Hours are Monday through Friday, 9:00 am to 1:00 pm. We ask that children show up on time and have arrangements to be picked up promptly at 1:00 pm.
Please make checks out to Sabill’s and mail, with all three forms, to 750 Southford Rd Southbury, CT 06488.
A confirmation will be sent to you via email upon receipt of your registration form and deposit.
Hold Harmless Agreement
The undersigned hereby agrees to indemnify and hold Scott Palmer, its Agents, and/or its Employees, and/or Sabill’s Morgan Horse Farm LLC harmless of any and all claims of injuries, death, damage to my person, and/or my personal and/or real property at the property, known as Sabill's Morgan Horse Farm LLC located at 750 Southford Road Southbury, Connecticut 06488, for any and all activities that the named participant below has contracted with Scott Palmer, its Agents, its Employees, and/or Sabill’s Morgan Horse Farm LLC, to participate on no specific date and as indicated herein. That the participant or its Parent and/or Guardian has read and understands the Connecticut Equine Activity Statute below, and in signing the HOLD HARMLESS AGREEMENT acknowledges that Scott Palmer, its Agents, its Employees, and/or Sabill's Morgan Horse Farm LLC, have not made any claims or misrepresentations as to the soundness and or safety ofthe horse(s) and/or equipment that have been provided to me for my use for any and all activities such as Horse Back Riding Lesson(s) that I have requested to participate in. That the undersigned named as participant and/or is Parent and/or Guardian, Hereby releases and discharges Scott Palmer, its Agents, its Employees, and/or Sabill’s Morgan Horse Farm LLC, from any all claims of injuries, death or damage to my person, and/or my personal property as a result from any activities that the undersigned participates in at its own free will and with out any reservations whatsoever.
Connecticut Equine Activity Statute GENERAL STATUTES OF CONNECTICUT TITLE 52.CIVIL ACTIONS CHAPTER'926. STATUTE OF LIMITATIONS Conn. Gen. Stat. s 52-577p (1994)S 52-577p. Assumption of risk by person engaged in recreational equestrian activates, when Each person engaged in recreational equestrian actives shall assume the risk and legal responsibility for any injury to his person or property arising out of the hazards inherent in equestrian sports, unless the injury was proximately caused by the negligence of the person providing the horse or horses to the individual engaged in recreational equestrian activities or the failure to guard or warn against a dangerous condition, us, structure or activity by the person providing the horse or horses or his agents or employees.
I have read the above and understand I am participating in a Horseback Riding Lesson under my own free will and at my own Risk.
Rider Name (print): ______
Parent/Guardian (print):______
Signature:______Date:______
(If Rider is 18+ years old, they may sign. If under 18, must have parent/guardian sign)
STUDENT REGISTRATION FORM
Name of Student:______
Date of Birth: ______
Parent orGuardian (If under 18 years old):
Name of Parent/Guardian: ______
Relationship to student: ______
Address: ______
City/Town: ______State: ______Zip: ______
Home Phone Number: ______
Cell Phone Number: ______
E-Mail Address: ______
Emergency Contact Information:
Name of Emergency Contact: ______
Cell Phone Number: ______
Home Phone Number: ______
Medical Information:
Doctor: ______Phone Number: ______
Allergies: ______
Any other things we should know?
______
Signature of Rider: ______Date: ______
(Must have Parent/Guardian sign if under 18)