ALL FORMS MUST BE SIGNED AND TURNED IN THE FIRST …



Pony Tails Riding CenterNikki Caudill Camp Registration 2019Camp is held at Nottingham Farms 6208 Kyles Station Rd. Liberty Township, OH 45011 Please mail the required non-refundable deposit of $100.00 for a (5) day camp and $75.00 for a (3) day camp and this completed form to: Nikki Caudill 3553 Julie Dr. Franklin OH 45005(513) 429-9081Checks payable to Nikki Caudill BALANCE OF $225.00 for a (5) day camp or $150.00 for a (3) day camp IS DUE FIRST DAY OF CAMP. The camper will not be allowed to participate if payment isn’t received on the first day.NO EXCEPTIONS! NO REFUNDS or CREDITS will be issued. I understand the camp’s policy is that in the event of a withdrawal or dismissal of my child from the camp for any reason, the camp fees will NOT be refunded. RELEASE OF LIABILITY The Undersigned assumes the unavoidable risks inherent in all horse related activities including but not limited to bodily injury and physical harm to horse, rider, or spectator. In consideration therefore for the privilege of riding and or working around the horses at Pony Tails Riding Center, the Undersigned does hereby agree to hold harmless and indemnify Nikki Caudill, Nottingham Farms, Megan and Bastiaan Oostdijck, property owners, heirs, employees, or volunteers and further release them from any liability or responsibility for accident, damage, injury, or illness to the Undersigned or to any family member or spectator accompanying the Undersigned on the premises. PURSANT TO OHIO REV. CODE 2305.321, persons engaged in the equine activities covered by the statue are not civilly liable and cannot be sued for injuries or damages which are sustained by another person who is also participating in an equine activity where the harm results from one or more of the “inherent risks” defined by the law. In the event I cannot be reached in any emergency, I hereby give my permission to Nikki Caudill to give permission to the selected physician to hospitalize, secure proper treatment of, and to order injection, anesthesia, or surgery for my child as named and parent/guardian is responsible for all costs incurred. I give permission for Nikki Caudill and Pony Tails Riding Center to use any photographs of my child for promotional material to promote our program. Parent/Guardian Signature ____________________________Date_______ Form must be filled out completely (Please Print) Child’s Name: ____________________________________________Age: ________ Parent’s Name (Printed): _______________________________________________ Address: _____________________________________________________________ City, State, & Zip: ____________________, ___________, ____________________ Phone: _______________________________ Cell ___________________________ Emergency Numbers: ________________________________________________ Email_______________________________________________ (for confirmation) Print clearly Date of camp__________ Shirts run small! Circle T-Shirt size Small 8/10 Medium10/12 Large14/16 XL 16/18 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download