Summer Horsemanship Camp Form – Babcock Hill Horses Naturally

Dawn Bonin Horsemanship LLC at Babcock Hill Horses Naturally LLC 577 Babcock Hill Rd Coventry, CT 06238

Name of parent or guardian(Required)

First Last

Name of child attending camp. This is the name referred to as child/ward throughout the rest of this document.

First Last

I grant permission for my child/ward to participate in the Horsemanship Camp. Please select week(s) you wish to attend below. Please include 50% deposit (checks made out to Dawn Bonin Horsemanship) with this emergency info form. Additional 50% due the first day of program.(Required)

Select week(s) you would like to attend(Required)

Pay in full June 27-30 10am-1pm 4-7yo

Pay in full July 11-14 9:30am-2:30pm 8yo+

Pay in full July 18-21 9:30am-2:30pm 8yo+

Pay in full both July weeks

Deposit June 21-24

Deposit July 19-22

Deposit July 18-21

Deposit both July weeks

You may select one or all weeks. The programs will be different each week. You may pay in full or submit a 50% deposit.

I will be paying:(Required)

Check

PayPal

Mail payments to: Dawn Bonin Horsemanship, 577 Babcock Hill Road, Coventry, CT 06238 Checks, credit cards and cash accepted at the event.

Total

Date of Birth(Required)

Phone Number(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Time of arrival(Required)

Time of departure(Required)

Child's Medical Information

Blood type

Food restrictions

Physician's name(Required)

Physician's Phone Number(Required)

Emergency contact numbers(Required)

Prescription or Over-the-counter Medication. I certify that I have included a doctors note, enlisting necessary medication that my child must take.(Required)

Authorized to Treat Minor Students In the event that I cannot be reached in an emergency. I hereby permit the concerned program directors to call 911 and/or to contact a medical facility or physician selected by the facility to provide proper treatment to child/ward. I will be responsible for all expenses arising in association with such treatment.(Required)

Permission to Photograph. I grant to Dawn Bonin/Babcock Hill, the right to take photographs of me and my family in connection with the above-identified program. I authorize Dawn Bonin/Babcock Hill, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Dawn Bonin/Babcock Hill may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.(Required)

Acknowledgment of Notification Regarding Risk. I hereby acknowledge that I have been notified the activities involved in this camp program are considered to be of 'high risk' to the participant.(Required)

Indemnity and waiver of claim. I, the undersigned, parent/legal guardian of child attending camp, hereby agree to indemnify and hold harmless Dawn Bonin Horsemanship LLC, its employees, volunteers, Babcock Hill Horses Naturally LLC, all owners and affiliations of property from any liability, lawsuit, cost, expense, or claim of any type whatsoever (including legal fees) for any harm, injury, or death arising out of the above mentioned activity, as a condition of the student participating in the kids day program.(Required)

Signature(Required)

Date(Required)

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name