Registration Form
Wild
Spirits
Spruce
Bank Farm, P.O. Box 188, Fergus, ON N1M 2W8
E-mail:
wildspiritsca@yahoo.ca
Riders
Name:________________________________ Health Card #:___________________________
Address:____________________________________
Emergency Contact:______________________
Phone:____________________________
Emergency Contact Phone: _________________________
Clinic:______________________________________
Clinic Date: _____________________________
Session/Level:
______________________________ Session Cost: ____________________________
Total
Due: $____________________________ Total Enclosed: $______________________________
Agreement
for Acceptance of Risk and Waiver of Liability.
I
request permission to participate (allow my child to participate) in horseback
riding and other activities at
Spruce
Bank Farm. I fully understand that horseback riding, handling and
grooming of horses and other stable activities are
very
dangerous. I wish to participate (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 me (my child)
or my property.
This
agreement is subject to the laws of the province of Ontario.
______________________________________________
__________________________________
Signature of Participant (or parent/guardian)
Date