2024 Breidablik Equestrian Farm LLC
Camp Release Form
2024 Breidablik Equestrian Farm LLC
Camp Release Form
This form is to be completed, signed and delivered to Breidablik Equestrian Farm before camp session begins. Please read this form carefully to ensure your understanding of your liability while at BREIDABLIK EQUESTRAIN FARM.
THE UNDERSIGNED HEREBY AGREES AS FOLLOWS:
_______________________________________
I herby certify that I am the Parent or Legal Guardian of the Child whose signature appears above. I have explained the assumptions of the risk contained herein to the Child and believe that the Child reasonably understands the risks involved and is willing to assume these risks. I believe that the Child understands the release of liability in favor of Breidablik Equestrian Farm, and that the Child has freely tendered such release and intends to be bound by its provisions. As a Parent or Legal Guardian of the Child, I hereby ratify the provisions of the foregoing agreement and agree to be by by its provisions.
Signature of Parent or Legal Guardian:
__________________________________________ Date: _____________________________
Printed Name of Parent or Legal Guardian: _________________________
Contact Phone Number: _____________________________
Emergency Contact: _______________________________
Emergency Contact Number: __________________________
Print full name(s) of Camper(s). Circle the appropriate skill level that best describes your Camper(s) ability.
Camper: ___________ Age: _____ Never Ridden / Beginner / Intermediate / Advanced
Camper: ___________ Age: _____ Never Ridden / Beginner / Intermediate / Advanced
Camper: ___________ Age: _____ Never Ridden / Beginner / Intermediate / Advanced
Does your Camper have any allergies? (please circle one) Yes or No
If yes, please explain: __________________________________________________
Amount Paid: ($100 Non refundable deposit along with shirt fee is due when registration is turned in to hold spot and ensure shirt)
Deposit (REQUIRED) amount: $_____________________ Check # if paying by check: #_______
Remaining Balance can be paid on the first day of camp at drop off or pre pay.
Full Day Full Week $600 per child $__________________________
Half Day Full Week $400 per Child $_________________________
Half Day – Please Specify AM or PM _________________________
Other Amount Per Child $__________________
Included with camp is a Breidablik Equestrian Farm T-Shirt.
WHAT SIZE WOULD YOUR CHILD WANT? MUST CIRCLE ONE:
CHILD XS S M L XL
ADULT XS S M L XL
Please circle which Camp(s) you are signing up for (separate checks or payments must be made for each camp):
July 8th - 12th or August 19th - 23rdTotal $__________________________ All Checks to be made out to BREIDABLIK EQUESTRIAN FARM
Camp Release Form
This form is to be completed, signed and delivered to Breidablik Equestrian Farm before camp session begins. Please read this form carefully to ensure your understanding of your liability while at BREIDABLIK EQUESTRAIN FARM.
THE UNDERSIGNED HEREBY AGREES AS FOLLOWS:
- That I, the undersigned for my child(ren), hereby voluntarily request to participate in activities at and around BREIDABLIK FARM. These activities include, but are not limited to, riding, leading, brushing and being around horses under the supervision of a BREIDABLIK FARM Camp Counselor.
- That I, as a Parent or Legal Guardian, understand that upon mounting the horse and taking up the reins, the Rider is in primary control of the horse, and that BREIDABLIK FARM is not responsible for the results of the Riders actions or inactions. I agree that should my Child(ren) abuse, misuse, r deliberately agitate the horse that these actions may result in increased risk to my child(ren) and / or others.
- I understand and agree that these activities will be on and around horses. I realize that even under well -supervised conditions, there is still risk involved. Horseback riding is a rugged adventure recreational sport activity and that there are numerous obvious and non-obvious inherent risks always present. Horses are 5 to 15 times larger, 20 t0 40 times more powerful, and 3 to 4 times faster than a human. If a rider falls from a horse to the ground it will generally be at a distance from 3 ½ feet to 5 ½ feet, and impact may result in injury to the Rider. If a horse is frightened or provoked it may divert from its training and act according to its natural survival instincts which may include but not limited to: stopping short, changing directions, changing its speed at will, shifting its weight, bucking, biting, kicking or running away from danger. I, for my Child(ren), hereby expressly assume any and all risks associated with their interaction with and riding of horses on and around BREIDABLIK FARM, including, without limitation, any injury to my child(ren).
- Conditions of nature and inspection of premises: I understand that BREIDABLIK EQUESTRIAN FARM is not responsible for total or partial acts or occurrences, or elements of nature that can scare a horse and cause it to react in some unsafe way. Some examples are: wind, thunder, rain, wild and domestic animals, insects, and natural or man-made changes in landscape. As the parent or legal guardian I have inspected BREIDABLIK FARM’s facility and are satisfied that all premises and conditions are reasonably safe for Riders intended purpose, usage and presence upon this property.
- Protective headgear warning: I understand that my child(ren) will wear protective headgear (ASTM/SEI approved riding helmet) and do understand that the wearing of such headgear while mounting, riding and dismounting may prevent or reduce severity of some head injuries and may even prevent death from happening as a result of a fall or other occurrence. ALL camp students are required to wear riding (ASTM/SEI approved) helmets while mounted.
- Accident / Medical Insurance: I agree that should my Child(ren) require medical treatment that the Camp Manager may authorize medical treatment of my Child(ren) as deemed necessary by paramedics or Doctors until such time as I arrive on the scene.
- Rules: I agree that my child(ren) will abide by BREIDABLIK EQUESTRIAN FARM rules at all times while on or around the BREIDABLIK FARM premises, with the full understanding that my Child(ren) might be asked to leave at any time if found in violation of the rules. Rules will be covered in depth on the first day of camp.
- Missed Camp Days: We understand that there are circumstances beyond our control (illness, injury etc.) that might prevent you and or your children from the entire camp session. We ask that notification be made to the Camp Manager by 8am on the day that your Child(ren) so activities are not delayed waiting for your Child to arrive. Camp days can not be made up. However, if a serious illness or injury prevents your Child(ren) from attending more than three days of camp, an effort will be made to place your Child in the next available session.
- RELEASE: I will not hold BREIDABLIK EQUESTRIAN FARM or its Owners, Employees or agents liable for any accident or injury to me, and / or my Child(ren), any person accompanying me, or for the loss or damage to any personal property belonging to me. I, for my Child(ren) and my and their successors and assigns, do hereby release, acquit and forever discharge BREIDABLIK EQUESTRIAN FARM and its Owners, Officers, Employees and Agents from any and all actions, causes of actions, suits, claims, promises, damages, demands and expenses of any kind whatsoever in law or in equity, arising out of or related to my or our activities on and around BREIDABILK EQUESTRIAN FARM, including, without limitation, riding horses.
_______________________________________
I herby certify that I am the Parent or Legal Guardian of the Child whose signature appears above. I have explained the assumptions of the risk contained herein to the Child and believe that the Child reasonably understands the risks involved and is willing to assume these risks. I believe that the Child understands the release of liability in favor of Breidablik Equestrian Farm, and that the Child has freely tendered such release and intends to be bound by its provisions. As a Parent or Legal Guardian of the Child, I hereby ratify the provisions of the foregoing agreement and agree to be by by its provisions.
Signature of Parent or Legal Guardian:
__________________________________________ Date: _____________________________
Printed Name of Parent or Legal Guardian: _________________________
Contact Phone Number: _____________________________
Emergency Contact: _______________________________
Emergency Contact Number: __________________________
Print full name(s) of Camper(s). Circle the appropriate skill level that best describes your Camper(s) ability.
Camper: ___________ Age: _____ Never Ridden / Beginner / Intermediate / Advanced
Camper: ___________ Age: _____ Never Ridden / Beginner / Intermediate / Advanced
Camper: ___________ Age: _____ Never Ridden / Beginner / Intermediate / Advanced
Does your Camper have any allergies? (please circle one) Yes or No
If yes, please explain: __________________________________________________
Amount Paid: ($100 Non refundable deposit along with shirt fee is due when registration is turned in to hold spot and ensure shirt)
Deposit (REQUIRED) amount: $_____________________ Check # if paying by check: #_______
Remaining Balance can be paid on the first day of camp at drop off or pre pay.
Full Day Full Week $600 per child $__________________________
Half Day Full Week $400 per Child $_________________________
Half Day – Please Specify AM or PM _________________________
Other Amount Per Child $__________________
Included with camp is a Breidablik Equestrian Farm T-Shirt.
WHAT SIZE WOULD YOUR CHILD WANT? MUST CIRCLE ONE:
CHILD XS S M L XL
ADULT XS S M L XL
Please circle which Camp(s) you are signing up for (separate checks or payments must be made for each camp):
July 8th - 12th or August 19th - 23rdTotal $__________________________ All Checks to be made out to BREIDABLIK EQUESTRIAN FARM