2022 Adult Registration Form

Today's Date*

Date

Rider's Information

Name*

First NameLast Name

Birth Date*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Riding Experience*

Walk/TrotCanterJumpNone

Gender*

MaleFemale

Height

Weight

Home Number*

Area CodePhone Number

Cell Number*

Area CodePhone Number

E-mail*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Do you have any allergies? If so, please specify

Do you have a medical history we should be aware of? If so, please specify

ACKNOWLEDGMENT OF RISK AND RELEASE OF LIABILITY –

Every person must read and understand this form before participating in equine activities.

To: Pat, Dewar and Hilary Laing and Peter Bombardier, CIDERMILL FARMS INC., CANADA SOUTH EQUESTRIAN EVENTS , and their directors, employees, officers, volunteers, business operators, and site property owners (all of them collectively called the HOST)

Please check each statement to acknowledge reading and comprehension of each statement below.

I Understand there are inherent DANGERS, HAZARDS AND RISKS (collectively called RISKS) associated with equine activities and injuries resulting from these “RISKS” are a common occurrence.I Acknowledge that the Inherent “RISKS” of Equine Activities mean those DANGEROUS conditions which are an integral part of Equine Activities, including but not limited to:·· The propensity of any equine to behave in ways that might result in injury, harm or death to persons on or around them and to potentially collide with, bite or kick other animals, people or objects.· The unpredictability of the equine reaction to such things as sound, sudden movement, tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface objects.· The potential for other participant(s) to act in a negligent manner that might contribute to injury to themselves or others, such as failing to act within their ability to maintain control over an equine.I Freely Accept and Fully Assume All Responsibility for the inherent “RISKS” and the possibility of personal injury, death, property damage or loss resulting from my Participation in Equine Activities.I acknowledge that it remains my Sole Responsibility to act in such a manner as to be responsible for my own safety and to Participate within My Own Limits, and to use safe and where necessary CSA approved equipment in accordance with the laws of Ontario while Participating in Equine Activities, including but not limited to, a CSA approved riding helmet for participants/competitors.In addition to my consideration given for my Participation in Equine Activity, I and my heirs, executors, administrators, and assigns (collectively called my “Legal Representatives”) agree · To waive all claims that I or the infant Participant might have against the “HOST” and· To Release the “HOST” from any and all Liability for any loss, damages, injury, or expense that I or my or “Legal Representatives” might suffer as a result of my Participation due to any cause whatsoever including any NEGLIGENCE ON THE PART OF “HOST” and· To HOLD HARMLESS AND INDEMNIFY THE “HOST” from any and all liability for property damage or personal injury to any third party which might result from my participation in Equine Activities.Before signing this form, I read it, and stated that I understand it. I know that signing this form waives certain legal rights I or my “Legal Representatives” might have against the “HOST”

Photo release*

I hereby grant permission to Cidermill Farms Inc to use photos and/or videos of my child in publications, promotional materials, online and in other communications related to Cidermill Farms business.

The rider agrees to abide by the Rider Code of Conduct.*

Always arrive with a positive attitude. Horses are sensitive to our emotions. It is important to approach the sport with respect and compassion.Respect your coach. The coach not only teaches you to ride, but understands the horse and is charged with their safety and well-being. If either is ever in question, the coach has the right to dismiss the rider.Follow safety guidelines on and off the horse. When riding wear boots with a heel, a helmet, pants and tie back long hair. When dismounted, no running or screaming in the barn, avoid the horse's back end, stay out of stalls and paddocks.

Medical Release and Authorization

I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of my life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury.

Permission is also granted to the Cidermill Farms and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to my admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

Cidermill Farms 2022 Registration for Adults