AZQualityHorses.Com Summer Camps
623-628-7663
Parent or Guardian:
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Address: ____________________________________________________________________
City: _________________________________State: _________ Zip: ______________
Home Phone: ________________ Work Phone: _______________ Other:_____________
Email address:
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Emergency Notification: _____________________________ Phone #:_______________
Doctor: _____________________ Phone: _______________ Insurance:________________________________________
Camper’s Name, sex & age,
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SUMMER CAMP 2009 June 8-12 $300 & June 17th-19th $150
How did you find out about camp? Check all that apply.
______ Newspaper ______ Friend ______ Family
______ Website ______ Other _____________________
TUITION: HORSEBACK RIDING CAMP-COVERED ARENA (9:00 A.M. TO 2 P.M.)………………….
Deposit: $100.00 PER CHILD, PER SESSION. NON-REFUNDABLE.
METHOD OF PAYMENT:
________ CHECK ________ CASH* PAYPAL ONLINE—CREDIT CARDS ACCEPTED*
RIDING LEVEL EVALUATION
Previous camper AZqualityhorses? YES or NO
If no, has your child attended any other riding camps or had riding lessons (please list)?
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Riding Level classifications are: (circle one)
Beginner: little or no riding experience
Novice: can ride a gentle horse at a walk or trot
Intermediate: can control the horse at a walk/trot and has cantered/loped before
HORSECAMP PARTICIPATION
RELEASE AND WAIVER OF LIABILITY AGREEMENT
I, _______________________________, (“Participant”) acknowledge that I have voluntarily applied to participate in the Horse camp held on ___________, at Dunn’s Arena, Litchfield Park, Arizona.
Under Arizona Law, a participant in equine activities assumes the risk of any injury, harm, damage, or death and any legal responsibility that may occur to participant resulting from the inherent risks associated with equine activities. Pursuant to Arizona Revised Statute, ARS 12-553, equine professionals are not liable for damages resulting from inherent risks of equine activities.
In signing this agreement, I (and through my legal guardian/parent if under 18 years of age) ACKNOWLEDGE THAT I AM AWARE THAT THE ABOVE-DESCRIBED ACTIVITIES ARE HAZARDOUS ACTIVITIES, AND I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE INHERENT DANGER INVOLVED IN HORSE RELATED ACTIVITIES, AND AGREE TO ASSUME ANY AND ALL RISKS OF DIRECT OR INDIRECT BODILY INJURY, DEATH OR PROPERTY DAMAGE.
As consideration for being permitted to participate in these activities and the use and property of Dunn’s Arena facilities, and AZ Quality Horses, I hereby agree that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives will not make a claim against, sue or attach the property of Dunn’s Arena or AZ Quality Horses or any of their affiliated sponsors or organizations for injury or damage resulting from the negligence or other acts, however caused, by any director, employee, agent, or contractor of the above listed organizations as a result of my participation in the activities described above. I forever release Dunn’s Arena, and AZ Quality Horses, and any of their affiliated sponsors or organizations from any and all action, claims, or demand that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives now have or may hereafter have for injury or damage resulting from my participation in the activities described above.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF, AZ QUALITY HORSES AND DUNN’S ARENA AND/OR THEIR AFFILIATED SPONSORS OR ORGANIZATIONS AND SIGN IT OF MY OWN FREE WILL.
PARTICIPANT/RELEASOR’S NAME
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PARTICIPANT/RELEASOR’S SIGNATURE OR LEGAL GUARDIAN
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ADDRESS:
_________________________________________________________PHONE:____________
