Old Orchard Farm March Break Camp Registration

Camper Name*
March Break Camp*
Event/Product
March Break Advanced Camp/ Show Prep Camp (You MUST pick quantity 1 in drop down, if you check out with quantity 0 the spot will not be automatically reserved for you).
$ 450.00
$

Payment Instructions

You may pay via email transfer to linda@oldorchardfarm.ca, cheque or by providing your credit card information below.  Please indicate whether you are paying the deposit or the full amount by selecting the correct box.

Choose Amount to Pay*
Choose Payment Method*
Expiration Date
Camper Birthdate*
Parent/Guardian 1 Name*

Address
Parent/Guardian 2 Name

Number of years
Riding Experience
How many times has camper fallen off of mount?
This information will assist in pony assignment
This information will assist in pony assignment
Is there any critical medical info that Old Orchard should be aware of?*

Acknowledgement of Risk and Release of Liability for Riders Under 18:  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 Understand there are Inherent DANGERS, HAZARDS and RISKS, (collectively called RISKS) associated withEquine Activities and injuries resulting from these “RISKS” are a common occurrence.     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 oraround 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 themselvesor others, such as failing to act within their ability or to maintain control over an equine     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 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.     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.  By acknowledging these clauses, I have read it and I understand it.  I further state I am aware that signing this form, waives certain legal rights I and/or the infant Participant and/or our "Legal Representatives" might have against Old Orchard Farm.Description Area

Acknowledgement of Risk and Release of Liability*
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