Summer Horsemanship Registration Form 2025

Summer Horsemanship Registration 2025

Program Days run from 9am to 3pm, price per week is $400/participant.
Participant Information
Participant's Name*

First NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
Does the participant have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the participant prescribed an inhaler or epi-pen? If yes, please explain any instructions.
Select Horsemanship Week(s)

A $100 non-refundable deposit per session will be required to hold your spot in the chosen session(s). Please choose from the following sessions:
Payments

One week of summer program is $400 per participant. A $100 non-refundable deposit is required to hold your spot for the preferred week! Any payments can be made via check or Venmo. Make checks payable to AZ-U-MAK-IT Farm, LLC and mail to 1658 Ocean St. Marshfield, MA 02050. Venmo is @azumakit-farm
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by AZ-U-MAK-IT Farm, LLC. during the selected program. In exchange for the acceptance of said child’s candidacy by AZ-U-MAK-IT Farm, LLC. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless AZ-U-MAK-IT Farm, LLC. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected program sessions. In case of injury to said child, I hereby waive all claims against AZ-U-MAK-IT Farm, LLC. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all equine and sports activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization As Parent and/or Guardian of the named participant, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s 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, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to AZ-U-MAK-IT Farm, LLC. and its affiliates including Instructors, Counsellors, and Supervisers to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered session. 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 of the named minor child, in my absence.
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*

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Summer Horsemanship Registration 2025

Select Horsemanship Week(s)

Payments