Little Learners at the Barn – Registration Form

Child Full Name

First NameLast Name

Preferred Name

Date of Birth

Date

Age

Home Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Parent/Guardian Name

First NameMiddle NameLast Name

Relationship to Child

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Address (if different from child’s home address)

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Emergency Contact Name

First NameLast Name

Relationship to Child

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Enrollment option

First choice day

Second choice day

Tuition reserves your child’s limited enrollment spot in the program. Monthly tuition remains due in full for September through May, including months that contain holidays, school breaks, or fewer scheduled program days, and tuition is not prorated for those calendar closures. June is billed only as a prorated amount based on the scheduled Little Learners program days before the June 3, 2027 school-year end.

Select a Tuition Payment Option

Tuition & Payment Acknowledgment

Allergies and medical considerations

Developmental or learning needs

Sensory sensitivities

Communication preferences

Behavioral or emotional support needs

Favorite interests or comfort items

Anything else staff should know

Which toileting status applies to your child?

Parent/guardian stay preference

Food allergies

Dietary restrictions or snack instructions

Animal Interaction Permission

Photo/Video Permission

Authorized Pickup Contacts

Additional Pickup Authorization Details

WARNING
UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), AN EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR DEATH OF A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES.

1. INHERENT RISKS AND ASSUMPTION OF RISK. I _________________________
acknowledge there are inherent risks associated with equine activities such as described below and hereby expressly assume all risks associated with participating in such activities. The inherent risks include, but are not limited to the propensity of equines to behave in ways such as, running, bucking, biting, kicking, shying, stumbling, rearing, falling or stepping on, that may result in an injury, harm or
death to persons on or around them; the unpredictability of equine's reaction to such things as sounds, sudden movement and unfamiliar objects, persons or other animals; certain hazards such as surface and subsurface conditions; collisions with other animals; the limited availability of emergency medical care; and the potential of a participant to act in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the animal or not acting within such participant's ability.

2a. I understand the potential dangers that I could incur in mounting, riding, walking, boarding, feeding said horse; including, but not limited to, any interactions with other horses. Understanding those risks I hereby release A Stable Learning LLC & Duck ‘N Stables, its officers, directors, shareholders, employees and anyone else directly or indirectly connected with A Stable Learning LLC & Duck ‘N Stables from any liability whatsoever in the event of injury or damage of any nature (or perhaps even death) to me or anyone else caused by or incidental to my electing to mount and ride a horse owned or operated by A Stable Learning LLC & Duck ‘N Stables.

2b. I understand and recognize and warrant that this Release and Hold Harmless Agreement, is being voluntarily and intentionally signed and agreed to, and that in signing this Release and Hold Harmless Agreement may further limit the liability of equine professionals to include any activity, whatsoever, involving an equine, including death, personal injury and/or damage to property.

2c. I recognize and agree that I know which equine professional(s) I will be working with, and acknowledge that I agree said equine professional(s) has/have made reasonable and prudent efforts to determine my ability to engage in the equine activity, and has/have sufficient knowledge of my equine and horseback riding skills as to relieve, release and hold harmless said equine professional(s) from any
continuing duty to monitor my equine activities.

Person voluntarily entering this Release and Hold Harmless Agreement:

Participant Name

Parent/Guardian Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

City/State/ZIP

Daytime Telephone

Please enter a valid phone number.Format: (000) 000-0000.

Evening Telephone

Please enter a valid phone number.Format: (000) 000-0000.

Policy Acknowledgements

Electronic Signature

Printed Name

First NameLast Name

Date

Little Learners at the Barn – Registration Form

Child Information

Parent/Guardian Information

Emergency Contact

Enrollment Selection

Tuition & Payment Options

Child Background and Support Needs

Toileting and Parent Stay Policy

Snack Information

Permissions

Authorized Pickup

Program Policies and Agreement

Assumption of Risk / Release Agreement