| Harvest View Stables Day Camps Registration Form - 2010 |
Date__________
Please register my son/daughter (name)___________________________________ for the period checked below. Find enclosed the required
non-refundable* reservation fee, which will be credited on my child's total tuition. I agree to pay the remainder of the fee prior to the first day of camp.
One-Day Camp: _____________________________ (date) Please enclose non-refundable registration fee of $25.00.
Multi-Day Camp: ________________________ (date) Please enclose non-refundable registration fee of $50.00
*Important note: if you must cancel your reservation, your deposit will be refunded only if your space can be filled.
Child's preferred name: _____________________________________________ Phone: _______________________________________
Address: ___________________________________________________ City: ______________________ State: ____ Zip: __________
Age: ________ Date of birth: ____________ Grade in school (as of Sept. 2010): _______________
Mother's name and phone: _______________________________________________________________________________________
Father's name and phone: ________________________________________________________________________________________
How did you learn of our program? ________________________________________________________________________________
Email addresses: Parents_____________________________________________ Camper_____________________________________
Riding experience and goals: ______________________________________________________________________________________
Has child attended riding camp in the past? __________ Where? __________________________________________________________
Please list medical conditions or other concerns: _______________________________________________________________________
Doctor's name and phone number: _________________________________________________________________________________
Emergency contact name and phone number: _________________________________________________________________________
AGREEMENT FOR RELEASE AND WAIVER OF LIABILITY: I fully understand that horseback riding, handling and grooming of horses and other
stable activities are very dangerous. All animals may be unpredictable, and while Harvest View Stables exercises care in the selection, training and use of its
horses, it is impossible to guarantee the behavior or actions of the horse at all times, or in all situations. I wish to participate or allow my child to participate in
these activities knowing that they are dangerous.
I accept and assume all the risks of injury (including death) to my child or myself or my property. I represent and warrant that I have the authority to give this
release.
In exchange for my child or myself being permitted to participate in these activities for my child, myself and my child's heirs, guardians and legal
representatives, I release and agree not to make or bring any claim of any kind against Harvest View Stables or its owners, directors or employees for any
injury (including death), to my child or myself, or any damage to my property whether from anyone's negligence or not, or any other cause, arising out of my
child's or my participation in these dangerous horseback riding or related activities or all other camp activities; I also agree that if anyone makes any claims
because of any injury to my child or myself (including death), or for any damage to my property, I will keep all those released by this agreement free of any
damages or costs because of those claims.
The undersigned hereby certifies that they are the legal parent or guardian of the child and that they desire the child to participate in the full program of all
activities, unless they provide other advice in writing. Further, that if the registrant should become ill or suffer an accident requiring medical attention, the
Directors of Harvest View Stables are granted full permission to take whatever action they may deem necessary or advisable, and to authorize appropriate
medical treatment, recognizing that every reasonable effort will be made to contact the parent or guardian. The undersigned agrees to be responsible for any
expenses incurred.
The parent or guardian (if registrant is under 18) or registrant must sign this form in order to be registered.
I hereby certify that I have read, understood and agree to abide by the conditions and agreements as outlined above.
Date: ____________ Signature: _____________________________________________
Please print name: ______________________________________________________
Return this form to: Harvest View Stables, 259 Lawn Hill Road, Manheim, PA 17545
(717) 665-2009; email: info@harvestviewstables.com; website: www.harvestviewstables.com
Please register my son/daughter (name)___________________________________ for the period checked below. Find enclosed the required
non-refundable* reservation fee, which will be credited on my child's total tuition. I agree to pay the remainder of the fee prior to the first day of camp.
One-Day Camp: _____________________________ (date) Please enclose non-refundable registration fee of $25.00.
Multi-Day Camp: ________________________ (date) Please enclose non-refundable registration fee of $50.00
*Important note: if you must cancel your reservation, your deposit will be refunded only if your space can be filled.
Child's preferred name: _____________________________________________ Phone: _______________________________________
Address: ___________________________________________________ City: ______________________ State: ____ Zip: __________
Age: ________ Date of birth: ____________ Grade in school (as of Sept. 2010): _______________
Mother's name and phone: _______________________________________________________________________________________
Father's name and phone: ________________________________________________________________________________________
How did you learn of our program? ________________________________________________________________________________
Email addresses: Parents_____________________________________________ Camper_____________________________________
Riding experience and goals: ______________________________________________________________________________________
Has child attended riding camp in the past? __________ Where? __________________________________________________________
Please list medical conditions or other concerns: _______________________________________________________________________
Doctor's name and phone number: _________________________________________________________________________________
Emergency contact name and phone number: _________________________________________________________________________
AGREEMENT FOR RELEASE AND WAIVER OF LIABILITY: I fully understand that horseback riding, handling and grooming of horses and other
stable activities are very dangerous. All animals may be unpredictable, and while Harvest View Stables exercises care in the selection, training and use of its
horses, it is impossible to guarantee the behavior or actions of the horse at all times, or in all situations. I wish to participate or allow my child to participate in
these activities knowing that they are dangerous.
I accept and assume all the risks of injury (including death) to my child or myself or my property. I represent and warrant that I have the authority to give this
release.
In exchange for my child or myself being permitted to participate in these activities for my child, myself and my child's heirs, guardians and legal
representatives, I release and agree not to make or bring any claim of any kind against Harvest View Stables or its owners, directors or employees for any
injury (including death), to my child or myself, or any damage to my property whether from anyone's negligence or not, or any other cause, arising out of my
child's or my participation in these dangerous horseback riding or related activities or all other camp activities; I also agree that if anyone makes any claims
because of any injury to my child or myself (including death), or for any damage to my property, I will keep all those released by this agreement free of any
damages or costs because of those claims.
The undersigned hereby certifies that they are the legal parent or guardian of the child and that they desire the child to participate in the full program of all
activities, unless they provide other advice in writing. Further, that if the registrant should become ill or suffer an accident requiring medical attention, the
Directors of Harvest View Stables are granted full permission to take whatever action they may deem necessary or advisable, and to authorize appropriate
medical treatment, recognizing that every reasonable effort will be made to contact the parent or guardian. The undersigned agrees to be responsible for any
expenses incurred.
The parent or guardian (if registrant is under 18) or registrant must sign this form in order to be registered.
I hereby certify that I have read, understood and agree to abide by the conditions and agreements as outlined above.
Date: ____________ Signature: _____________________________________________
Please print name: ______________________________________________________
Return this form to: Harvest View Stables, 259 Lawn Hill Road, Manheim, PA 17545
(717) 665-2009; email: info@harvestviewstables.com; website: www.harvestviewstables.com
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