Horse Camp Registration Form

Is your child crazy about horses? Are you looking for a unique activity filled with horses? Then our Camps are for you!

What will I learn?
This Equine Assisted Learning camp is designed to create bonds, and promote safety all while having fun. Camp activities are designed to build meaningful connections with our horses, fostering a sense of responsibility, respect, and resilience.
Join us for a unique adventure where the lessons learned from our equine partners extend far beyond the arena, leaving campers with lasting skills and memories to cherish.

* Please Note that all activites will be from the ground with no riding*

What do I need to bring?
• Boots with a heel
• Weather Appropriate Clothing
• Long pants for riding
• Lunch and snacks and lots of water
• Helmet or Bike Helmet
• Change of clothes and layers

When do I come to camp?
• Camp runs from 9:00am to 3:00pm

What is the cost?
• Our camp is $190 per Camper

Registration and Payment options
• Registration forms must be submitted through this form.
• Payment can be submitted via cash or etransfer to charlotte@paintedhilltop.com with the password camp
• A non-refundable deposit of $50 is due with submission

Camper Name*

First NameLast Name

Camper Age*

Name(s) of Parent(s)/Guardian(s)*

Cell Phone Number - Can we text you? Yes or No*

Email*

example@example.com

Would you like a Receipt emailed to you?

NoYes

Address*

Incase of emergency contact?*

Family Doctor*

Health Card Number

Any allergies or medical conditions we should be aware of?*

What best describes the Campers riding experience *

T Shirt Size*

Which camp(s) are you registering for?*

August 15

Media Release

I authorize Painted Hilltop Farm Summer Camp to record my child’s image and voice while participating in programs.

I understand and agree that these audio, video, film and print images may be edited, duplicated, distributed, reproduced, broadcasted, and reformatted in any form and manner without payment of fee in perpetuity.

I also give permission to Painted Hilltop Farm to use photographs, audio and video of my child for promotional purposes, including but not limited to the web site, Annual Report, Newsletter, Summer Camp Guide, and other marketing and communication materials.

Do you Authorize Permission?*

I do authorize permissionI do not authorize permission

THIS SECTION MUST BE SIGNED BY PARENT AND/OR GUARDIAN BEFORE REGISTRATION IS ACCEPTED.

In consideration of being allowed to participate in any way in Painted Hilltop Farms equestrian program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
I KONWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary term and conditions for participation. If, however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Painted Hilltop Farm, their officers, officials, and/or employees, other participants, and , if applicable, owners and lessors of premises used to conduct the event(“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

I, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Signature*

PAINTED HILLTOP FARM - CHARLOTTE BECKER
130 CHEMIN DU RANG A, OTTER LAKE
QUEBEC J0X2P0
Email: charlotte@paintedhilltop.com
Phone: 819-647-8945