•    Safe, kind, and dependable horses who love children; a staff  of lifetime-experienced instructors for any discipline and all seats

•    Indoor and outdoor riding arenas and groomed trail

•    Focus on safety and fun; creating a positive riding experience and                   building self-confidence through achievement.

•    Accepting a maximum of 10 riders for each summer camp program on            a first come, first serve basis. Ages 5 and up; 2:1 rider to instructor ratio

Requirements:
•    A riding helmet (or bicycle helmet.)
•    A comfortable ½ inch heel shoe or boot (no tennis shoes)

Cost:
•    $300 per rider, per week: $75 deposit (non-refundable) per rider is                   required two weeks before camp session attending; $225.00 balance due at arrival of rider at camp. (Call or email for last minute slot availability!)

..........................................................................................................................................

Rider Name:__________________ __________________ Age:_____    
                                        (last)                                 (first)

Riding ability:
 no previous experience   some experience   Taking lessons/ride often

Parent(s) name:____________________________________________
Phone during camp hours____________________________________

Street Address and city: _____________________________________
Home phone: _____________________________________________

Make checks payable to:      CornerStone Acres, Too

                              Mail to:       6090 Dell Road,
                                                  Saline, MI  48176

 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

In consideration of CornerStone Acres, Too; located at 6090 Dell Road, Saline, Michigan, and Gerry A. Eaton or her assigned agent(s), hereinafter referred to as THE EQUINE ACTIVITY SPONSOR, permitting me and/or my minor child(ren) _______________________________________________ to engage as an active participant in equine related activities, and

Understanding, acknowledging and agreeing that engaging in equine related activities could be hazardous and may result in injury:

I agree to assume all risks of injury arising out of participating in the equine related activities, either off or upon the premises of THE EQUINE ACTIVITY SPONSOR.

I release and agree not to sue THE EQUINE ACTIVITY SPONSOR, its agents, employees, servants or anyone connected with its association, from any and all liability for any claim for injury, damages, costs or causes of action which me or my minor child(ren) have or may have in the future as a result of injuries or damages sustained by me or incurred by me while participating in such equine activity, either off or upon the premises of THE EQUINE ACTIVITY SPONSOR.

I agree not to invite or permit any other person(s) to enter the premises or to engage in any equine activity as a guest. Any such participant shall be deemed a trespasser, not an invitee, unless such person(s) execute(s) an "Equine Activity Agreement and Release" with THE EQUINE ACTIVITY SPONSOR.

I further agree to indemnify THE EQUINE ACTIVITY SPONSOR, it agents, employees, servants or anyone connected with its association, for any costs, expenses, damages or legal fees which maybe incurred as a result of any breach or violation of this "Agreement and Release." If such breach results in injury or death to any person(s) engaging in such equine activity, I further waive and hold safe THE EQUINE ACTIVITY SPONSOR without regard to whether such injury or death is alleged to have resulted from any alleged acts of negligence of THE EQUINE ACTIVITY SPONSOR, its employees, agents, or anyone connected with its association.

WARNING
Under the Michigan Equine Activity Equine Act, an equine professional is NOT liable for an injury to or the death of participant in an equine activity resulting from an inherent risk of the equine activity (PA 351 of 1994)

I have read and under stand the above terms of this agreement and release, and I agree to such terms.

_____________________  Date: ___________________
Equine Participant

_____________________ Date: ___________________ 
Parent or Guardian signature if participant(s) is/are under 18 years of age
     

By signing this document I/we _______________________the parent(s) and/or legal guardian(s) of _____________________ ______________ authorize my child’s instructor or designee listed below to seek First Aid and medical attention for my child. In the event of an emergency, I further give further permission to the licensed physician chosen by these designees to hospitalize, secure treatment, anesthesia, or surgery for the previously listed child.

Child’s Name: ___________________________________

Child’s Address:__________________________________ _______________________________________________

Date of Birth: _____________

Parent or Guardian’s name: __________________________

Address: ________________________________________

Home phone: ______________ Work phone: ____________

Emergency contact(s): ______________________________
Phone: __________________________________________

Instructor or Designee: ______________________________
Instructor or Designee Address:_______________________ ________________________________________________

Family Doctor:_____________________________________
Phone: __________________________________________
Family Doctor Address: _____________________________ ________________________________________________

Allergies: ________________________________________

Medications:______________________________________

Past Medical History: _______________________________
_______________________________________________
_______________________________________________

Insurance Information: ______________________________ ________________________________________________



________________________  Date: __________________
Signature of Parent or Guardian

       
________________________  Date: __________________
Printed name of Parent or Guardian