The Happy Horse, LLC FARM CAMP
Riding Instruction Agreement/ Liability Release (initial each section)
AGREEMENT:
I, ______represent that I am the parent or legal guardian of: ______. I have had ample time to consider this agreement, and I wish for my child to participate in Farm Camp and receive horseback riding and horsemanship instruction from Victoria Hicken and or her appointed Instructors. (______)
Risks/Informed Consent:
I understand that horseback riding is a contact sport. That being in the presence of farm animals and horses or ponies (equine activities); involvesdangers, hazards, and risks. That these are “inherent”; meaning they are an integral part of participating in an equine activity or farm activity. That these risks include but are not limited to:
A. Being kicked, bitten, stepped on, pushed, pulled, thrown or otherwise falling from the horse while standing or in motion. Or colliding with another horse,object, or rider at any given rate of speed.
B. That horses and farm animals such as sheep, goats, chickens, etc. are live animals and have the potential to react in unpredictable ways to other animals, people, sounds and objects. A horse or farm animal’s behavior/disposition can change from day to day. There can be variations in terrain and unpredictable ground conditions.
C. That injuries to a rider, persons handling horses or farm animals on the ground, or spectators are a common occurrence in equine activities and farm activities. Those injuries include but are not limited to; sprains, strains, contusions, concussions, lacerations, broken bones, head, neck, and back injuriessome of which may be permanent or result in the death of a participant. (_____)
By signing this agreement I am stating: I am aware of the previously mentioned risksand believe the benefits of my child participating in Farm Camp that includes activities involving horses or ponies (equine activities) and farm animals,outweigh the risks for injury or illness. (______)
LIABILITY RELEASE
“WARNING UNDER NEW JERSEY LAW, AN EQUESTRIAN AREA OPERATOR IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN EQUINE ANIMAL ACTIVITES RESULTING FROM THE INHERANT RISKS OF EQUINE ANIMAL ACTIVITIES, PURSUANT TO P.L. 1997, C.287 (c.5:15-1 et seq.)
1. No suit shall be instituted by the child or the parents or guardian of a camper, jointly or severally, against the property owner, Victoria Hicken, The Happy Horse LLC, Instructors, or volunteers, to recover damages or loss actually or allegedly resultant to the parents of the child or to either of them by reason of an injury or fatality which, while on the premises or off the premises, either for instruction, in connection with instruction, or competition, such students shall sustain.
2. The child or parents of the child (camper) of The Happy Horse LLC, Victoria Hicken and her appointed Instructors, agree to save Victoria Hicken,The Happy Horse LLC, any owner, Instructor, employee, volunteer, harmless against any and all claims, demands, or suits, which shall be brought by anyone not signatory hereto and which shall be predicated upon any such injury or fatality so sustained by a child (camper) of The Happy Horse LLC, Victoria Hicken or her appointed Instructors. This agreement is intended to be as broad and inclusive as the law permits. If any clause, phrase, or word of this agreement is in conflict with state law, then that single part is void; all other aspects of the agreement remain in force.
3. This combined pledge against suit and promise of indemnification shall be effective immediately and shall automatically terminate if and when Victoria Hicken, The Happy Horse LLC, receives written notice of termination signed by either or both of the child (camper)’s parents. Termination however, shall not affect application of the forgoing previsions, (1) and (2), for any mishap, which shall have previously occurred.
4. The Happy Horse LLC, Victoria Hicken, Instructors, land owners, employees, or volunteers are not responsible for personal property damage, loss, or theft while on or off the premises.
I hereby agree to the foregoing as the: Parent/ Legal guardian of above-mentioned child (camper). Both parents must sign
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Father/Legal Guardian (signature) Date Mother/Legal Guardian (signature) Date
The Happy Horse LLC Farm Camp Registration
Mail completed form to PO Box 57, Atco NJ, 08004
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Name Age Date of Birth ______/______NJ ______Address Town Zip
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Home phone Cell Phone Work phone Email
*Camper scheduling: pleasecircle desired week or weeks of camp you are registering for. Regular camp hours are 8:30am to 2:30pm. A 3:30 “late pick-up” is available for an additional $75.00 per week, and must be arranged in advance.
There is a $50.00 non- refundable deposit due with this registration. Final payment of $195.00 (+$75.00 if using late pick up) is due three days prior to the start of Camp. Campers should bring daily: hand sanitizer, a packed lunch, 4 drinks (water or juice), and 2 snacks. Friday is “Pizza Party” day and lunch is provided by a local pizza shop. * Please do not send any peanut products with your child.*
2016 Week #1: June 27th – July 1st Week #2: July 11th – 15th Week #3: August 22nd - 26th
_____ Schedule me for daily late pick-up at 3:30pm. I will add $75.oo for each week to my final payment
Has Camper ridden horses before? Y N Times per week? ______Where? ______When was Child’s last ride? ______
Has Child ever fallen while riding? Y N If yes; when? ______Has Child ever been injured while riding? Y N
If yes, please explain details of incident and any injury: ______
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Child’s Height ______Weight ______(this information assists in placing Camper with appropriate sized horse/pony)
Does Child have an IEP at School? Y N Copy Provided? Y N
Medical Conditions or Allergies: ______
Who may pick up your child? (1)______(2)______
If your child is injured, attempts will be made to notify you immediately. Basic first aid will be initiated; if further medical attention is needed and we cannot reach you; 911 will be contacted and your child will promptly be taken to the nearest Emergency Department by local EMS. ALL medical expenses related to patient transport and medical care provided, are your responsibility.
By signing below I am giving Victoria Hicken and or her appointed Instructors/Volunteers consent to obtain emergency medical treatment for my child. I understand and agree that I am personally responsible for any and all medical expenses incurred.
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Parent/ Legal Guardian (Print Name) Date
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Parent/ Legal Guardian (Signature) Date