BURNT HILL STABLES
ALL DAY HORSE CAMP
CHARGE $40.00

JUNE 21, 2007

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: _____________________________

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:______________________________________