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Camp/Lesson Waiver of Liability

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Riding Lesson / Summer Camp Application and Waiver of Liability (Child)

Taylor Made Farm
2448 Quarry Rd, Holicong, pa 18928 
 
Applicant’s Name:______________________________________  Birth Date:___________________________
Address:__________________________________________________ State:______________ Zip:__________
 Height:_____ Weight:_____Previous Riding Experience:______________________ 
Allergies – Medical problems:_________________________________
 Mother’s Name:____________________Address :___________________________________
Home Phone:_______________
CellPhone:_______________________
 Father’s Name:_____________________ Address :___________________________________
Home Phone:_______________
Cell Phone:_____________________________________
 Parent’s email Address:_______________________________________________________________________  
   
  RELEASE: The undersigned acknowledge that they are the parents or legal guardians of the applicant and are executing this release with full authority and knowledge of the risks inherent in equine activities.  In consideration of our child being permitted to participate in the equine activities at Taylor Made Farm, we knowingly assume the risk of death or injury to our child and property and agree we will be responsible for, and hereby release Taylor  Made Farm LLC on which the equine activities are conducted, Jennifer Ramins, John Roach, Lisa Ritzen Sontag,  and any person associated with the equine activities at Taylor Made Farm from any and all loss, liability, damage, attorneys' fees or costs, for injury to or death of our child, ourselves, or our property that may occur during or arise from  the inherent risks associated with lesson ,day camp and riding activities, including, but not limited to swimming, day trips, riding lessons, trail rides, exercise, jumping, caring for horses before and after riding, foxhunting, showing, etc.
 WE ACKNOWLEDGE THE FOLLOWING NOTICE:                   
 "You assume the risk of equine activities pursuant to Pennsylvania law,
"Signatures:____________________________________________________________________ Date:__________ 

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