TPH Summer Clinic Registration Form

Which clinic are you attending?

Rider’s Name

First NameLast Name

Birth Date

MonthDayYear

Gender

T-shirt size?

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

(if applicable)

Name

First NameLast Name

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Alt. Phone Number

Format: (000) 000-0000.

Describe your experience level briefly if we have never done lessons together.

Can we post pictures of you or your child on Facebook?

A deposit is due to hold your spot in this clinic. (Check the info form for your clinic to know the amount due).

I am aware that the remainder of the camp fee is due one week before the camp’s start date.

Tell me any issues you are having with your horse or what you would like to gain the most from this clinic?

1. I agree that horseback riding and all equine activities are inherently dangerous activities AND that these activities will expose me to above normal risks of bodily injury and/or death.

2. I agree that I am responsible for my own safety while engaging in any and all equine activities on the Owner’s property.
3. I agree to acknowledge all of Owner’s rules and regulations pertaining to any and all equine activities on Owner’s property and I agree to and am responsible for wearing protective gear appropriate for equine activities to ensure Rider’s safety while engaging in such activities.
4. I understand the risks involved in equine activities and I AGREE TO ASSUME ANY AND ALL RISKS INVOLVED IN RIDER’S USE OF OR PRESENCE UPON OWNER’S PROPERTY AND FACILITIES while engaging in any equine activity without limitation and including the risks of death, bodily injury, property damage, falls, kicks, bites, unavailability of emergency medical careand/or the ordinary negligence and/or deliberate act of another person.
5. I agree that Owner, the Owner’s stable, its agents, instructors, and employees are NOT liable for any injury to or the death of Rider and/or participant in equine activities resulting from the inherent risks of equine activities.
6. I agree to hold Owner, Owner’s stable, its agents, instructors, and employees completely harmless and not liable and release them from all liability whatsoever, including acts of ordinary negligence, associated with any equine activity during the Rider’s use of or presence upon Owner’s property.
7. I AGREE NOT TO SUE Owner, Owner’s stable, its agents, instructors and/or employees in association with ANY claims, damages, costs, or expenses arising out of Rider’s use of or presence upon Owner’s property and facilities while engaging in any and all equine activities including those based on death, bodily injury, and property damage, unless the damages are caused by the direct, willful and wanton gross negligence of the Owner.
8. Rider confirms that they have complete and full insurance coverage on himself/herself and personal property.
9. Rider and Rider’s parent or guardian, (if Rider is a minor) agree that this agreement and release of liability is a contract that when signed by the parties involved will be legally binding to all parties, subject to the above terms and conditions and shall be enforced and interpreted under the laws of the state of Louisiana.
“Under Louisiana law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities.“ Pursuant to R.S. 9:2795:1

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.

Date

Signature

Tipton Performance Horses Clinic Registration

Rider Information

RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT