Clinic Registration Form

 Blazing Star Stables Registation Form

Rider/Handler____________________________Age_________ Phone______________

 

Address_____________________________________Town_______________

 

Email____________________________________

 

Horse______________________________Age:______  Breed:___________

 

Coggins:_________________Rabies____________Other_________________

 

 

Please Circle Clinic Date:

 

April 15^th           May 6^th           June 16^th         July 1^st           August 5^th          August 19^th   

Session 1              $40             $30/person          $30                   $30                     $30

     $30                                                                                                    Both $55

Session 2

      $30

 

Statement of Inherent Risks: The Owner and agent understand and recognize that activities involving horses (including but not limited to their handling and riding) involves inherent risks and can result in injury to the horse, rider, and bystanders.  These risks include but are not limited to, the following:  (i) The propensity of horses to behave in ways that may result in injury, harm, or death to persons on or around the horse. (ii) The unpredictability of a horse’s reaction to such things as sounds, sudden movements and unfamiliar objects, persons, or other animals. (iii) The potential of other riders to act in a negligent manner that may contribute to injury to the owner and/ or agent or to others, such as failing to maintain control over the horse or not acting within his or her abilities.  Owner understands and acknowledges that one’s presence upon the premises of a farm or horse stable and horseback riding bear known and unknown risks.  These risks could result in injury, death, illness, disease, emotional distress, or damage to self, property, or to third parties.  Owner understands that these risks simply cannot be eliminated without jeopardizing the essential qualities of the activities. Owner has adequate insurance to cover any injury or damage that Owner, or owner’s horse may cause or suffer while participating in this activity; or else Owner agrees to bear the cost of such injuries or damage their self.  Further Owner has no medical or physical conditions that could interfere with safety in this activity, or Owner has discussed this and made Katherine L Murphy aware of situation.

 

 

 

Signed_______________________________Date__________________

 

 

Please remember that slot will be held only when payment is received. Post dated checks are accepted.