After School Program

RIDING NIGHTS & AVAILABILITY *

Your child will attend class one night a week for 9 consecutive weeks. Please check ALL the days that your child is AVAILABLE. The greater a rider's AVAILABILITY, the more flexibility we will have in placing them in the BEST CLASS suited for their experience and interest. Our Horsemanship Coordinator will contact you prior to the start of the program to finalize riding nights.

I am available Tuesday evenings

I am available Wednesday evenings

I am available Thursday evenings

I am available Friday evenings

Rider's Full Name *

First Name

Last Name

Rider's Birthday *

MM

DD

YYYY

Main Phone Number *

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Second Phone Number

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Guardian Name (1) full name *

First Name

Last Name

Guardian (1) Main phone

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Guardian (1) Second Phone

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Guardian Name (2)

First Name

Last Name

Guardian (2) Main Phone

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Guardian (2) second phone

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Alternative Emergency Contact Name *

First Name

Last Name

Phone Number *

(###)

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Does your child have any health problems/medical conditions/allergies/special needs? *

Yes

No

Does your child carry an EPI-Pen? *

Yes

No

PERMISSION

I desire my child to participate in the After-School Program (operated by Sarah Parks) for the 9 week session, including all activities unless I advise otherwise in writing. The price of the program is $675.00 + HST = $762.75 for a 9 week session or $84.75.00 per session (HST included) if a “one time” session is arranged with the Coordinator. I agree that if my child fails to complete the program, the fee will not be refunded.

I AGREE

PAYMENT

Registrations are received on a first come, first serve basis. Payment: I am aware that I must submit payment at the time of registration to secure my spot in the program. Payments can be made by etransfer, cash or cheque. (sorry - no credit cards or debit) * Please make cheques payable to Sarah Parks and mail to: 7150 County Rd 20, RR#5, Amherstburg, On, N9V OC8. Send etransfers to: info@sarahparkshorsemanship.com

I AGREE

ABSENCE *

I have notified the Coordinator of any pre-planned vacation. In the event that my child cannot attend the program and an alternative date cannot be arranged I am aware that my fee will not be reimbursed.

I AGREE

HOW TO PREPARE FOR OUR RIDING PROGRAMS

Snacks & Drinks We will be breaking in between activities, bring snacks and plenty to drink to refuel and stay hydrated. Dress for the Weather We will be outdoors in the elements so bring what you need to stay warm and comfortable in the evenings. Come with extras that help dress you for the weather, and that may include gloves, sweaters or jackets, and rain boots. Hats and sunscreen are encouraged year round. Footwear and Clothing Boots or shoes with a heel are recommended. Rain boots or runners are acceptable. Absolutely no open-toed shoes are to be worn at any time. Long pants or sweat pants are acceptable to wear but we do not advise wearing nylon or slippery pants. We will supply riding helmets. (Riders can bring their own if they have them.)

I AGREE

I am the Parent and/or Legal Guardian of the infant Participant *

1. I am the Parent and/or Legal Guardian of the infant Participant named above and am executing this form on behalf of the infant Participant in my capacity as parent and/or guardian and with the intent that this form be binding on myself and infant Participant for all legal purposes.

I AGREE

DANGERS, HAZARDS and RISKS, *

2. I Understand there are Inherent DANGERS, HAZARDS and RISKS, (collectively called RISKS) associated with Equine Activities and injuries resulting from these “RISKS” are a common occurrence.

I AGREE

Inherent “RISKS” of Equine Activities *

3. I Acknowledge that the Inherent “RISKS” of Equine Activities mean those DANGEROUS conditions which are an integral part of Equine Activities, including but not limited to: • The propensity of any equine to behave in ways that might result in injury, harm or death to persons on or around them and to potentially collide with, bite or kick other animals, people, or objects. • The unpredictability of an equine’s reaction to such things as sounds, sudden movement, tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface objects. • The potential for other participant (s) to act in a negligent manner that might contribute to injury to themselves or others, such as failing to act within their ability or to maintain control over an equine. * the potential of natural or man-made hazards being present that can cause me harm, including communicable disease*

I AGREE

Accept and Fully Assume All Responsibility *

4. I Freely Accept and Fully Assume All Responsibility for the Inherent “RISKS” and the possibility of personal injury, death, property damage or loss which might result from the infant being a Participant.

I AGREE

Sole Responsibility of Parent/ Guardian *

5. I Acknowledge that it remains my Sole Responsibility for the safety of the infant Participant and for the infant to Participate within his/her own limits.

I AGREE

Release of liability of Sarah Parks Horsemanship *

6. In addition to consideration given for the infant to Participate in Equine Activity, I and my heirs, executors, administrators and assigns (collectively called my “Legal Representatives”) agree: • To Waive All Claims that I or the infant Participant might have against the “HOST”; and • To Release the “HOST” from Any and All Liability for any loss, damages, injury, or expense that I, the infant Participant or our “Legal Representatives” might suffer as a result of the infant’s Participation due to any cause including any NEGLIGENCE ON THE PART OF THE “HOST”; and • To HOLD HARMLESS AND INDEMNIFY THE “HOST” from any and all liability for property damage or personal injury to the infant Participant or to any third party which might result from the infant’s Participation.

I AGREE

Participant Termination *

Sarah Parks Horsemanship is committed to providing all participants (Clients) in our programs with a positive experience. By purchasing our services, the participant agrees that Sarah Parks Horsemanship may, at its sole discretion, terminate this Agreement, and limit, suspend, or terminate Client’s participation in our programs without refund if Client becomes disruptive or endangers Sarah Parks Horsemanship employees, volunteers or participants, Client fails to follow the Program guidelines, is difficult to work with, impairs the participation of the other participants in the Program or upon violation of the terms as determined by Sarah Parks Horsemanship. Client will still be liable to pay the full amount owing for services rendered.

I agree

Rider Participant Signature *

I AGREE

Guardian Signature *

I AGREE

Guardian's Full Name *

First Name

Last Name

Guardian's Birthday *

MM

DD

YYYY