Loving Thunder Summer Camp!

Camper Name*

First NameLast Name

Camper Age All Abilities*

Riders required age must be between 7 to 15 years of age.

Date of Birth*

Date

Camper Height

Camper Weight Lbs*

Weight must be less than 180 Lbs. Our horses well being and stress is very important to us. Our weight limit is 180 Lbs.

Male or Female?

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Email Address*

example@example.com

Parent/Guardian Phone Number*

Please enter a valid phone number.

How did you hear about us?

Goals: (ie. Why are you applying for participation? What would you like accomplish?

If your camper has emotional, physical, or developmental disabilities please explain here.

Photo Consent! Consent to and authorize the use and reproduction by Loving Thunder Therapeutic Riding, Inc. of any and all photographs and any other audio/visual materials taken of me for promotional material, educational activities, and exhibitions or for any other use for the benefit of the program*

ConsentDo not consent

I agree to adhere to the billing policies of Loving Thunder Therapeutic Riding, Inc as follows: Lessons are to be paid in full according to the most current rate sheet before the lessons start. I understand that not showing up for a lesson is non-refundable and cannot be made up. If a cancellation is made by Loving Thunder staff, then riders’ account(s) will be credited accordingly. Privacy Policy: We will not share your information in any way unless you have requested in writing such disclosure. Client, Parent or Legal Guardian Signature*

I, (parent/guardian) of hereby (participant) and have voluntarily registered him/her to participate in an activity of horseback riding with Loving Thunder Therapeutic Riding, Inc.

I fully understand that the activity of horseback riding, or even being near a horse, involves numerous dangers and risks of injury to me. I acknowledge that the assumption of all the risks involved in my responsibility and I completely release Loving Thunder Therapeutic Riding Inc and its agents from all liability for any and all injuries caused by my participation in the general activity of horseback riding.

I fully understand that an animal(horse)irrespective of its training and usual past behavior and characteristics, may act or react unpredictably based on instinct or fright, and that even the most gentle horse, when provoked or frightened, may rear buck, run away or otherwise act in an unpredictable and dangerous manner.
In addition, weather such as wind, thunder, hail, lightening, or snow sliding off of the roof, may cause a horse to rear, buck, run away or otherwise act in an unpredictable and dangerous manner.

Having understood these dangers, I fully assume all of the risks involved and completely release Loving Thunder Therapeutic Riding, Inc and its agents from liability for any and all injuries to me from the general activity of horseback riding.

I fully understand that riding on any type of terrain can be dangerous to my horse and me and that this danger increases when riding a horse fast, such as a canter (LOPE) OR AT A GALLOP. Under these conditions, or even while riding at a slower pace, my horse may stumble, be thrown off balance, get caught in a hole or rut, fall, or otherwise be dangerous to me. I also fully understand that I may, at any time, lose control of and/or fall off my horse, or have a collision.

I fully assume the responsibility for all of these dangers and risks, and completely release Loving Thunder Therapeutic Riding, Inc and its agents from all liability for any and all injuries to me from the dangers and risks as stated above.

I fully understand that animals (horses) and conditions are unpredictable and that the risk of injury or death is inherent to the activity of horseback riding and/or being around horses. I fully assume the responsibility for the risk of injury or death caused by my contact with horse and horseback riding. I completely release Loving Thunder Therapeutic Riding, Inc. and its agents from any and all liability for any and all injuries or death to me caused by my contact with horses and/or horseback riding.

I agree not to sue, claim against, attach the property of or prosecute Loving Thunder Therapeutic Riding, Inc, its officers, board members, affiliated organizations, agents and / or its employees for horseback riding and its related activities, whether or not such injury or death was caused by their negligence or from any other cause.

I agree to release the State of New Mexico and all of its agencies, agents, contractors, servants and employees from liability for any acts of Loving Thunder Therapeutic Riding, Inc causing injuries arising out of premises operation, acts of independent contractors, products completion, or personal injuries sustained due to Loving Thunder Therapeutic Riding, Inc's negligence in connection with providing services under this contract.

I agree to defend, indemnify and hold harmless Loving Thunder Therapeutic Riding, Inc. and all of its officers, board members, affiliated organizations, agents and employees for any injury or death caused by or resulting from my participation in the activity of horseback riding and its related activities, whether or not such injury or death was caused by their negligence or form any other cause.

This agreement shall be legally binding upon me, my family, my heirs, my estate, assigns, legal guardians, and my personal representative. I have carefully read this agreement and fully understand its contents. I am aware that I am releasing certain legal rights that I otherwise may have and I enter into this release of liability and indemnity agreement on behalf of myself of my own free will. Please initial to show that you agree
THIS IS A RELEASE OF LIABILITY. DO NOT SIGN THE RELEASE IF YOU DO NOT UNDERSTAND AND/OR AGREE WITH THE TERMS.
Participants under 18 years of age require the signature of a parent or legal guardian.

Client, Parent or Legal Guardian Signature*

Name:   First Name   Last Name
DOB:   Date
Phone:   Area Code   Phone Number
AddressStreet AddressState   Zip
Physician’s Name:   First Name   Last Name
Preferred Medical Facility:   Medical Facility
Health Insurance Company:   Insurance Co
Policy #:   Policy #
Allergies to medications:   Allergies to medication
Current medications:   Medications
In the event of an emergency, contact:
Name:   First Name   Last Name
Relation:
Phone:   Area Code   Phone Number
Name:   First Name   Last Name
Relation:
Phone:   Area Code   Phone Number
Name:   First Name   Last Name
Relation:
Phone:   Area Code   Phone Number