Participant Name:
*
First Name
Last Name
Address:
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date of Birth:
*
MM
DD
YYYY
Rider's Height:
*
Rider's Weight: (required to match your rider with a suitable horse or pony)
*
Has your child ever ridden before?
*
Please include experience below. You may be required to send a short video if your rider has previous experience
What is your child's swimming experience?
*
Is there any other information we should know about the rider?
e.g. Allergies, medical conditions, requests to be with other campers etc.
Parent/Guardian Name:
*
First Name
Last Name
Address (if different than participant)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email:
*
Home Phone:
(###)
###
####
Work Phone:
(###)
###
####
Cell Phone:
*
(###)
###
####
May we contact you by text message?
*
Emergency Contact Name and Information:
*
If anyone other than a parent/guardian will be picking your child up please list name and phone number of individual:
May we use photos of your child to promote our programs on Willowcrest Farm social media and website?
*
ASSUMPTION OF RISKS, RELEASE OF INTEREST, WAIVER OF CLAIM, AND INDEMNITY AGREEMENT
*
THIS AGREEMENT MUST BE COMPLETED IN FULL, SIGNED, DATED, AND WITNESSED BEFORE ANY ACTIVITY WITH HORSES MAY BE UNDERTAKEN.
BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS INCLUDING THE RIGHT TO SUE.
PLEASE READ CAREFULLY!
To: Julie Diamond/Willowcrest Farm
(referred to in this agreement
AND TO: ALL PROPERTY OWNERS (PRIVATE, FEDERAL, PROVINCIAL, REGIONAL AND MUNICIPAL)
On my behalf, and on the behalf of any minor children participating in these activities, for whom I am legally responsible, I agree to the following:
ASSUMPTION OF RISKS:
I am aware and understood that activities involving these horses involve many risks, dangers and hazards, including, but not limited to the following:
1. Horses, which are powerful and potentially dangerous animals, may change their behavior at any time and may, without warning, jump, run wildly, buck, kick, bite or step on people or things:
2. Horses may collide with other horses or objects or trip, stumble or fall even if being led, ridden, or attended to;
3. Negligence (which means, in general terms, a failure to exercise ordinary or proper care) of other riders or my or my child's failure to ride safely;
4. Equipment may fail;
5. Weather conditions can change and can sometimes be dangerous;
6. The nature of the terrain can change and has certain risks associated with it including, but not limited to, exposed natural objects, trees, streams and creeks;
7. The activities can sometimes be in remote areas and injuries or illness may occur and it may be a considerable distance to doctors,
hospitals, or any other type of assistance; and
8. Negligence on the part of A PROPERTY OWNER AND/OR THE PROVIDER OR THEIR STAFF.
I am also aware that the risks, dangers and hazards referred to above exist throughout the trail, stable, practice and other areas and many are unmarked. I understand and acknowledge that no amount of caution, experience and instruction can eliminate all of the risks involved and I freely accept and fully assume all such risks, dangers and hazards and the possibility of personal injury, death, property damage and damages or loss resulting there from.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of the Provider providing me or my child with their horses or sleigh riding and other services and permitting my or my child's use of their equipment, and other facilities and the Property Owners providing me or my child with the use of their property (hereinafter collectively) referred to as "the Services"), I hereby agree as follows:
1. TO WAIVE ANY AND ALL CLAIMS that I or my child have or may in the future have against a Property Owner or the
Provider, and their directors, officers, employees, agents, representatives, and volunteers (all of whom are hereinafter collectively referred to as "THE RELEASEES") and to RELEASE THE RELEASEES from any and all liability for any loss, damage, injury
or expense that I or my child may suffer, or that my or my child's next of kin may suffer as a result of my or my child's use of the services or due to any cause whatsoever, INCLUDING NEGLIGENCE,BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE OWED UNDER "THE OCCUPIER'S ACT" ON THE PART OF THE RELEASEES;
2. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damages to the property of or personal injury to any third party resulting from my or my child's use of the services;
3. This Agreement shall be effective and binding upon my or my child's heirs, next of kin, executors, administrators, assigns and representatives in the event of my or my child's death or incapacity;
4. This agreement shall be governed by and interpreted in accordance with the laws of the Province of Ontario ; and
5. Any litigation involving the parties to this Agreement shall be brought within the Province of Ontario.
PROTECTIVE HEAD GEAR & RIDING BOOTS
1. Proper riding footwear is required by all persons, regardless of age, participating in any horse related activities.
2. ALL MINORS (Horse back riders under years of age) are required to wear protective head gear in the form of a high
impact helmet and proper footwear.
3. IT IS HIGHLY RECOMMENDED THAT ALL HORSE BACK RIDERS OF ANY AGE WEAR A HIGH IMPACT HELMET.
4. I (we) decline to wear a helmet(s).
In entering into this Agreement, I am not relying upon any oral or written representations or statements made by the Releasees other than what is set forth in this Agreement.
I HAVE READ AND UNDERSTOOD THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT, FROM
THIS DAY FORWARD, I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I, MY CHILD, MY HEIRS, NEXT OF KIN,
EXECUTORS, ADMINISTRATORS, ASSIGNS AND/OR REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES.
Thank you so much for your business! I can’t wait to meet your child and teach them about horses!
As a reminder, a non-refundable deposit in the amount of $150 must accompany this completed form to hold your child’s camp spot.
Payments are accepted by e-transfer to jjjdiamond@hotmail.com, or by cheque.
Please make cheques payable to Julie Diamond.
