BURNT HILL STABLES

REGISTRATION AND RELEASE FORM

Participant’s Name: _____________________________

Age: _____

Parent/Guardian Name:__________________________

Emergency Contact Person:_______________________

Phone: (__________________ )

Parent’s Name:_____________________________________

Mailing Address:

Street: ___________________________________

City: ____________________________

State: ______ Zip: ________ Home Phone: ______________

Business Phone or Cell: _____________________

E-Mail: _____________________________

CLASS SIGN UP

Beginner Group Lessons 4 Lessons @ $20hr. $80 Pre-Pay at sign up.

___Monday 6:30pm-7:30pm

___Tuesday 5:30pm-6:30pm                    ____Tuesday 6:30pm-7:30pm

Intermediate Lessons 4 Lessons @ $20 hr. $80 Pre-Pay at sign up

___Monday  5:30pm-6:30pm

           ___Thursday  5:00pm-6:00pm                    ____Thursday 6:00pm-7:00pm

For information on Private orSemi-Private (two students) Lessons contact Burnt Hill Stables.

READ CAREFULLY BEFORE SIGNING

LIABILITY RELEASE (Required): ____________________________(Name) would like to participate in the Burnt Hill Stables Riding Program. I acknowledge the risks and potential for risks of horseback riding and related equine activities, including grievous bodily harm. However, I feel that the possible benefits to myself/my child/my ward are greater than the risk assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors, and administrators, waive and release forever all claims for damages against Burnt Hill Stables, its Instructors, Volunteers, and/or Employees for any and all injuries and/or losses I/my child/my ward may sustain while participating in the Program.

The undersigned acknowledges that he/she has read this Registration and Release Form in its entirety; that he/she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date: ________Signature:______________________________________