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Rider's Name*

First NameLast Name

Rider's Age*

Parent's Name (if under 18)

First NameLast Name

Email*

example@example.com

Who is completing this form?*

What is your relationship to the Rider? (Please note adult rider or legal guardian must sign release form prior to riding)*

I am the riderI am the parent or guardianI am a family member (not legal guardian)Other

Phone Number*

Please enter a valid phone number.

Desired Camp - Full camps can be added to wait list for cancellations!*

Kids Camp - Fall Oct 10-13 2023 FULL, add to waitlistKids Camp - Winter Dec 26-29 2023Kids Camp - Spring 2024Adult Camp - Spring 2024Kids Camp - Summer #1 - June 2024Kids Camp - Summer #2 - June 2024Advanced Kids Camp - July 2024 (Approval Required by Al)Kids Camp - Summer #3 - July 2024Other

I would like to purchase a shirt for my rider. *By selecting the size below you agree to pay an additional $25 for Camp Shirt**

Adult & Kids Camp Refund Policy...If refund is requested, funds may be transferred to lessons scheduled schedule, and must be used within one year of purchase date. Funds can also be transferred to another camp, but transfer can only occur once. No cash refunds available. Funds can also be transferred to another participant if client wants to.*

I understand the Refund PolicyI have questions about the policyI disagree with the policyOther

Participant Release - Known by all present: The undersigned understands and agrees that there is inherent risk of injury in all equine-related activities, both mounted and non-mounted. It is understood that horses may stumble, bite, run, or make unpredictable movements which may cause a participant to be injured by or fall from the horse. I am willing and able to accept full responsibility for my own safety and welfare and my family’s. I do hereby release and discharge Al’s Horse Academy, it’s instructors, staff, volunteers and horse owners from any and all responsibility or liability to me, my child, or my family in connection with any injuries or disease suffered by me, my child, or my family as a result of my activity, participation and attendance involving Al’s Horse Academy horses/ponies, property or events.*

I agree to the Participant Release for my child, myself and my familyI have questions about the Participant ReleaseOther

Photo Release - I hereby grant Al’s Horse Academy and all entities permission to use any and all photographs, slides and any other audio visual materials in which I may appear for the express purpose of promoting Al’s Horse Academy programs and I do not expect, nor shall I receive any monetary reimbursement for this authorization.*

I agree to the Photo ReleaseOther

Medical Information for Participant - Please let us know below if participant has any medical or allergy conditions we need to know about. This includes ADHD, Autism, allergic to anything, etc. This will help our staff keep all riders safe. If medication is needed please give it to Management with name clearly printed with directions for application. For participants who develop allergies while at Academy, the participants' affected area will be washed. Then the Academy will contact the parent/guardian for further instructions. If Academy is administering medication per your permission, and the participant is exhibiting allergy symptoms including, but not limited to: facial swelling, other excessive swelling or trouble breathing, or if another emergency occurs which Management believes requires a 9111 call, Academy will call 911 before contacting the parent/guardian. The parent/guardian accepts full medical financial responsibility for the participant.*

The participant has a medical condition described belowThe participant has an allergy described belowThe participant is healthy, with no medical or allergy conditionsOther

Medical or Allergy Conditions

Emergency Contact - if other than parent information above

First NameLast Name

Emergency Contact Phone Number - if other than parent information above

Please enter a valid phone number.

How will you pay?*

My Products

Kids CampEnter description

$195.00

Adult Camp

$165.00

Camp T-ShirtMust pay here in order to receive order.

$25.00

Total

$0.00

Pay by Credit Card

Registration for Horse Camp

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