Apple Tree Farm Student Information and Release Form

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Rider Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Date of Birth* This field is required.
Date
Year
Month
Day
4
Parent Names- for students under 18* This field is required.enter n/a if not a minor.
Mother Name
Mother email
Father name
Father email
5
Phone Numbers* This field is required.How can we reach you for cancellations/changes to lesson schedule or emergencies? Computer users: Enter n/a for any numbers that don't apply. Cell Phone users: Enter 000-000-0000 for phone numbers that don't apply.
Rider Cell
Rider Home
Mom Cell
Dad Cell
Mom Home
Dad Home
Mom Work
Dad Work
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Any other important adults/phone numbers not included above? For example: grandparents/other legal guardians we will see regularly. .
Please include: Name/ relationship/phone number
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Rider Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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In case of an emergency, contact: * This field is required.
Name
Relationship
Please enter phone
9
Does the rider have any medical conditions or learning disabilities that we should know about? * This field is required.Enter N/A if this does not apply.
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10
Please list all medications that the Rider is currently taking: * This field is required.Enter N/A if this does not apply
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11
Briefly describe riding experience: * This field is required.Enter "none" if first time rider.
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12
Medical Release* This field is required.In the case that I am unable to be reached, I hereby agree that Alison Eastman-Lawler, Ann Grenier, and/or Apple Tree Farm staff in conjunction with medical personnel shall make medical decisions on my behalf, in my absence, while my child is participating in Apple Tree Farm activities.
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Rates* This field is required.Effective 2/2020 ALL PRICES SUBJECT TO CHANGE. LESSONS: Regular Lesson Slot (RIDERS OVER 7, paid monthly)- $180/month Pay by the lesson - $50 Private lesson with Alison - $75 Private lesson with staff - $65 1/2 hour private - $40 Winter riding fee (once/year due in Nov. for riders using lesson horses) $130 Tiny Trotter Program: 1/2 private weekly lesson: $160/month Child will receive a make up lesson if they have to miss a lesson. If your child doesn't ride weekly: $40/lesson (Time slot not guaranteed- scheduled around those students that have a monthly time slot.) BOARDING RATES: Wheeler Road Board: $760 - this includes your weekly lesson. Pay before the 1st of the month and deduct $30. Indoor Winter Board: $905 - this includes your weekly lesson. Pay before the 1st of month and deduct $30. COACHING: Sanctioned Events: $90 Schooling Events: $75 Fun Shows (Town Ring): $75 Trailering Fee: Depends on distance to event.
I have read and understand
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General Release and Liability, Hold Harmless and Indemnity Agreement for Equine and Equine Related Activities:* This field is required.This agreement is made between Alison Eastman-Lawler d/b/a Apple Tree Farm, Shawn Lawler, Lucinda Eastman, Hollis Horse Farm, LLC, Scarlet Hill Farm and/or any additional landowners where such equine activities may take place, owners of any horses that may be used at Apple Tree Farm by Rider in lessons or for events/shows, and Rider and Rider's parents or guardian, if Rider is a minor. In consideration of the use and enjoyment of Apple Tree Farm's property, property of Lucinda Eastman, Hollis Horse Farm, LLC, Scarlet Apple Farm, and/or additional landowners where such equine activities may take place and the services, training, skills, animals or facilities, today and for all future dates, where for fee or not, Rider and Rider's parent(s) or guardian(s) on behalf of Rider each, and their heirs, and assigns hereby release, hold harmless and indemnify Alison Eastman-Lawler d/b/a Apple Tree Farm, Lucinda Eastman, Hollis Horse Farm, LLC, Scarlet Apple Farm, owners of any horses that may be used by Rider in lessons or for other equine related activities. Apple Tree Farm agents, employees and assigns,, for any and all activity in any way related to equine activities, including but not limited to any activity for which the Rider and/or Parents may be present on Apple Tree Farm property or property owned by Lucinda Eastman, Hollis Horse Farm, Scarlet Apple Farm, including as a spectator. Rider and Rider's parent(s) or guardian(s) on behalf of Rider agree as follows: 1. If only one parent signs this agreement, that parent represents that they have the authority to sign on behalf of and thereby bind both parents. 2. Rider and Parents agree to abide by all rules and regulations of Apple Tree Farm. 3. Rider and Parents agree to carry insurance on their personal property and themselves. 4. Rider and Parents understand and agree that horseback riding in all respects, including but not limited to riding on the flat in a ring, jumping fences or other obstacles, slippery and rough footing, etc. can be a very dangerous activity, and they wish nevertheless to participate. 5. Rider and Parents agree that any work done by them without monetary compensation in and around Apple Tree Farm does not make them employees or agents of Apple Tree Farm. 6. Rider and Parents recognize that they are voluntarily participating in equine activites at Apple Tree Farm. Rider and Parents assume and accept all risks involved in or in any way arising from their use of, or presence upon, the property of Apple Tree Farm, Lucinda Eastman, Hollis Horse Farm, LLC, Scarlet HIll Farm, and/or additional landowners where Apple Tree Farm equine activities may take place, including but not limited to bodily injury, death, property damage, and the unavailability or emergency medical care, or any other loss or damage, even if the method of injury or loss or the nature or extent thereof are not contemplated at the time or signing of this agreement. 7. Rider and Parents acknowledge that by signing this agreement Alison Eastman d/b/a Apple Tree Farm’s legal rights will extend to those found under RSA 508:19 and beyond to the greatest extent permitted by New Hampshire and South Carolina law. 8. Rider and Parents understand and agree that under New Hampshire and South Carolina law, a participant in equine activities assumes the risk of any injury, harm, damage, or death, and any legal responsibility that may occur to participants from the inherent risks associated with equine activities and further agrees that PURSUANT TO R.S.A. 508:19 EQUINE PROFESSIONALS ARE NOT LIABLE FOR DAMAGES RESULTING FROM INHERENT RISKS ASSOCIATED WITH EQUINE ACTIVITIES. 9. By signing this document, Rider and Parents agree to not bring any claim of any kind whatsoever against Alison Eastman d/b/a Apple Tree Farm, Shawn Lawler, Lucinda Eastman, Hollis Horse Farm, LLC, Scarlet Hill Farm, owners of any horses that may be used by Rider in lessons or for other equine related activities done at or under the auspices of Apple Tree Farm, Apple Tree Farm agents, employees and assigns, for any and all activity in any way related to equine activities, including but not limited to any activity for which the Rider and/or parents may be present on Alison Eastman d/b/a Apple Tree Farm property, Shawn Lawler, Lucinda, and/or Hollis Horse Farm, LLC, Scarlet Hill Farm premises, including as a spectator. In addition, Rider and Parents agree to indemnify and hold harmless Alison Eastman d/b/a Apple Tree Farm, Shawn Lawler, Lucinda Eastman,, Hollis Horse Farm, LLC, Scarlet Hill Farm and the owner of any horse that may used by Apple Tree Farm for lessons or other equine related activities, from any claims that may be brought, and that such indemnity will extend to any amounts for which the aforementioned parties may be liable, including attorney fees, costs and judgments. 10. NOTWITHSTANDING ANYTHING CONTAINED WITHIN, RIDER AND PARENTS UNDERSTAND THAT THIS AGREEMENT IS INTENDED TO AND DOES EXTEND TO CLAIMS OF ANY KIND, INCLUDING THE NEGLIGENCE OF ALISON EASTMAN D/B/A APPLE TREE FARM, SHAWN LAWLER, LUCINDA EASTMAN, HOLLIS HORSE FARM, LLC, SCARLET HILL FARM AND THE OWNERS OF ANY HORSE THAT MAY BE USED BY APPLE TREE FARM FOR LESSONS OR OTHER EQUINE ACTIVITIES, APPLE TREE FARM AGENTS, EMPLOYEES, WHETHER ALLEGEDLY DUE TO THEIR ACTIONS OR THE ACTIONS OF NEGLIGENCE OF THIRD PARTIES. BY SIGNING THIS AGREEMENT, RIDER AND PARENTS UNDERSTAND THAT ALISON EASTMAN D/B/A APPLE TREE FARM, SHAWN LAWLER, LUCINDA EASTMAN, HOLLIS HORSE FARM, LLC, SCARLET HILL FARM, AND THE OWNERS OF ANY HORSE THAT MAY BE USED BY APPLE TREE FARM FOR LESSONS OR OTHER EQUINE ACTIVITIES, APPLE TREE FARM AGENTS, EMPLOYEES, WILL NOT BE RESPONSIBLE FOR THE CONSEQUENCES OF THEIR OWN NEGLIGENCE. 11. This agreement constitutes a contract made and entered into in the State of New Hampshire,and the State of South Carolina and shall be enforced and interpreted under the laws of this State. Should any clause herein be declared invalid by a New Hampshire or South Carolina court, all other clauses shall remain in full force and effect.
I have read and understand
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Cancellation Policy* This field is required.Lesson cancellation policy applies to all students. We require a minimum of 24 hours notice of cancellation or you will be charged for that lesson and no makeup will be given. If a lesson is canceled due to inclement weather, or illness, then the student will take a makeup at a different time than their regularly scheduled lesson. Makeup lessons must be taken within 60 days of missed lessons. It is the student’s responsibility to call to schedule makeups. You may not apply your makeup lesson as credit in the next month, you must pay full fee for the month. Rain Cancellation Policy- Just a reminder, if the weather is questionable call the barn. We will *TRY* to send out e-mails or call directly if lessons are cancelled. If it is cold plus drizzle we usually cancel. If it is warm and drizzly then we have lessons (usually). For thunderstorms, we always cancel. Please understand the difficulty predicting NH weather! Sometimes we may cancel based on radar/forecasts, and the storm never materializes. In the winter, lessons *MAY* be cancelled in the event of extreme cold, snowy weather, and/or icy bad roads. If your lesson is in the morning I will call you directly. You will be able to schedule makeups for lessons missed due to inclement weather.
I have read and understand
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Covid Release* This field is required.The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Apple Tree Farm has put in place preventative measures to reduce the spread of COVID-19; however, we cannot guarantee that you or your guests will not become infected with COVID-19. Further, attending Apple Tree Farm events could increase your and your guests risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I or my guests may be exposed to or infected by COVID-19 by attending Apple Tree Farm events and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 atApple Tree Farm may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Apple Tree Farm employees, volunteers, and event participants and their families or guests. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself or my guests (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at Apple Tree Farm or participation in Apple Tree Farm events. I hereby release, covenant not to sue, discharge, and hold harmless Apple Tree Farm, its employees, agents, and representatives, of and from the claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Apple Tree Farm, its employees, agents, and representatives, whether a coronavirus, COVID-19 infection occurs before, during, or after participation in any activity at Apple Tree Farm.
I have read and understand
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SIGNATURE For General Release and Liability, Hold Harmless and Indemnity Agreement for Equine, Covid Release and Equine Related Activities:* This field is required.
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