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Rider Information | |||
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Mailing Address: City |
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Parent/contact |
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Emergency Contact |
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Please advise of any medical conditions, ie. asthma, allergies, ADD, other. |
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Has your child received any psychological/psychiatric/family therapy in the last 12 months? |
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Is your child currently taking any medication? |
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Please note that all medications should be forwarded to the Camp Director with full doctor's instructions. Under NO circumstances should a child carry his/her medication unsupervised. |
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Medical/Release Form | |||||||
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The rider/camper and/or his/her parent(s) and/or guardian(s) hereby acknowledge the risks and hazards inherent in riding and working around animals, not to be limited to: horses, chickens, dogs and cats and agree to assume all responsibility and risk of bodily injury or damage to property and further agree to hold harmless and indemnify Corner Stone Farm and its owners, employees, volunteers, agents, and representatives from all claims for any bodily injury to persons or damage to property arising out of or resulting from the camper's use of Corner Stone Farms’ premises or use of horses at or from Corner Stone Farm , as a rider, groom or spectator or otherwise in any type of Corner Stone Farms organized, sponsored, supported or endorsed activity, whether on Corner Stone Farm premises or elsewhere, and including transportation provided Corner Stone Farm or the individuals or organizers referred to herein. The camper and his/her parent(s) and/or guardian(s) do hereby consent to any medical examination, treatment or medical services that may be rendered to said camper under the general or specific instructions of any physician or hospital. It is understood that this consent is given in advance of any specific diagnosis or treatment. The camper and the undersigned parent(s) and/or guardian(s) agree to assume responsibility for payment of all fees for doctors, hospitals, ambulances and/or other medical charges reasonably and necessarily incurred. Insurance is the responsibility of the rider/camper and/or his/her parents. The camper and his/her parent(s) and/or guardian(s) do hereby consent that photos/images of the camper/rider may be used in Corner Stone Farms articles and advertisements without payment or remuneration to that said camper/rider. | |||||||
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Deposit and camp fee agreement | |||||||
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A deposit of 50% of the camp fee is to be attached with your registration form. Any incomplete forms will not be accepted. If you have any questions about filling out the forms please contact Cathy. Please note that the balance of camp fees must be received no later than 2 weeks prior to your child's camp session. After this time Camp fees are non-refundable. Should you need to withdraw your child from camp, arrangements can be made to credit your child for an alternate camp session during the current season (subject to availability and discretion of camp director). All deposits are non-refundable. Make checks payable to:Cathy Colwell 2891 Hwy 15 RR# 6 Kingston K7L 4V3 I hereby declare that in making this entry I have read and fully understand and agree to the terms and conditions stated herein, and that it is binding on my executors, heirs and assigns. Date: _______________ Signature : _________________________________________
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Corner Stone Farm
Short Course Eventing
Welcome to a new sport called Short Course Eventing it expands the Combined Test concept and also includes
Cross Country type fences in an expanded Stadium course.
Riders begin with a Dressage test, followed by a combined Stadium and Cross Country jumping course.
Jumping begins with Stadium fences on our grass jumping ring, then without stopping, continues out of the ring over solid and knock down jumps, rolling terrain, small banks, shallow ditches and then back into the ring to finish over more stadium fences. Total times faults and rails down. Combined with the dressage scores for placings.
Coaching is welcomes.. Safety a priority.
Entrants can choose to show dressage only or enter in one or two levels of competition. No horse may be ridden in more than two divisions on whole or in part.
Awards given to only the highest level completed.
Ribbons to Fifth for both Overall and Dressage tests.
ENTRY FORM
Corner Stone Farm
Short Course Eventing
INTRODUCTION TO EVENTING
8:30 a.m. Sunday , June 14, 2009.
Please print and mail completed prior to closing date.
Entries that are not complete will go into the reserve list for entries and are not guaranteed as entered to the show. A refund of 90% will be given to those competitors who can present a vet certificate or doctors certificate.
Rider: __________________________ [ ] JR [ ] SR
Horse Name : ____________________________
Telephone_____________________
Address: ______________________________________________
OEF # _______________________
copy of coggins attached _____ (yes)
Fees: $80.00 PER DIVISION
You can ride in more than one division but will only receive ribbons for “overall” placings in the highest division you complete. Ribbons also awarded to the top five best dressage scores in each division.
50.00 Dressage only
Division (check box for all that apply)
Dressage Only [ ] 50.00
Dressage - Cross-Country – Stadium [ ] 80.00
Starter up to 2’ 0”
Dressage Only [ ] 50.00
Dressage - Cross-Country – Stadium [ ] 80.00
Pre- Entry up to 2’ 6”
Dressage Only [ ] 50.00
Dressage - Cross-Country – Stadium [ ] 80.00
Course development fee : 5.00
DRESSAGE TEST:
Walk/ Trot division – called Pre- Starter Cadora Walk/ trot Test A
Tests avail at www.cadora.ca
Starter and Pre-Entry 2005 CEF Entry Division Test A
Tests avail at www.cadora.ca
MUST BE SIGNED BY PARENT OT GUARDIAN --NOT COACH etc
Complete and Mail, prior to closing date:June 1,2009.
Cathy Colwell 2891 Hwy 15 RR#6
Other info:
No post-dated cheques
No refunds after Closing date
Refunds before closing date with Dr or Vet certificate minus 10% admin fee
NSF cheques will be subject to a $30 charge
Food booth on site
Participant’s Name: __________________________
Date of Birth: ________________ Address: City: Prov:____ Postal: The Participant must Read and Understand prior to the Participant Participating in Equine Activities
TO: Catherine Colwell and Joseph McAllister _ their directors, employees, officers. (Name of Person, Organization or Company providing the Equine Activities) volunteers, business operators, and site property owners. (all of them collectively called the HOST)
Initial each item below After
_____1. I am the Parent and/or Legal Guardian of the infant Participant named above and am executing this form on behalf of the infant Participant in my capacity as parent and/or guardian and with the intent that this form be binding on myself and infant Participant for all legal purposes.
_______2. 1 Understand there are Inherent DANGERS, HAZARDS and RISKS, (collectively called RISKS) associated with Equine Activities and injuries resulting from these “RISKS” are a common occurrence.
_________3. I Acknowledge that the Inherent “RISKS” of Equine Activities mean those DANGEROUS conditions which are an integral part of Equine Activities, including but not limited to:
• The propensity of any equine to behave in ways that might result in injury, harm or death to persons on or around them and to potentially collide with, bite or kick other animals, people, or objects.
• The unpredictability of an equine’s reaction to such things as sounds, sudden movement, tremors, vibrations. unfamiliar objects, persons or other animals and hazards such as subsurface objects.
• The potential for other participant (s) to act in a negligent manner that might contribute to injury to themselves or others, such as failing to act within their ability or to maintain control over an equine.
__________4. I Freely Accept and Fully Assume All Responsibility for the Inherent “RISKS” and the possibility of personal injury, death, property damage or loss which might result from the infant being a Participant.
__________5. 1 Acknowledge that it remains my Sole Responsibility for the safety of the infant Participant and for the infant to Participate within his/her own limits.
__________6. In addition to consideration given for the infant to Participate in Equine Activity, I and my heirs, executors, administrators and assigns (collectively called my “Legal Representatives”) agree
• To Waive All Claims that I or the infant Participant might have against the “HOST”; and
• To Release the “HOST” from Any and All Liability for any loss, damages, injury, or expense that I. the infant Participant or our “Legal Representatives” might suffer as a result of the infant’s Participation due to any cause including any NEGLIGENCE ON THE PART OF THE “HOST”: and
• To HOLD HARMLESS AND INDEMNIFY THE “HOST” from any and all liability for property damage or personal injury to the infant Participant or to any third party which might result from the infant’s Participation.
Before signing this form I read it (as indicated by my initials above) and I stated that I understand it. I further state I am aware that signing this form, waives certain legal rights I and/or the infant Participant and/or our “Legal Representatives” might have against the “HOST”.
SIGNED This ______________ day of____________________________ 2009.
Catherine Colwell - McAllister and Joseph McAllister (Print Name of HOST Witness to signing & Initialing)
(Signature of Participant) ________________________________
(Signature of Do Not Sign until you Understand All Items Above )
______________________________________
(Signature Host Witness)
ACKNOWLEDGMENT of RISK and RELEASE of LIABILITY “For Participants Not 18 Years Old”
Please Print Clearly
Infant Participant’s Name: _____ __________________________________ Date of Birth: Infant’s Address: __________ __________________________City: Prov: Postal:
Guardian’s Name: ________________________________________________ Date of Birth: Guardian’s Address: City: ______Prov: Postal:
The Guardian must Read and Understand prior to the Infant Participating in Equine Activities TO: Catherine Colwell - McAllister Joseph McAllsiter and Corner Stone Farm their directors, employees, officers.
(Name of Person, Organization or Company providing the Equine Activities) volunteers, business operators, and site property owners. (all of them collectively called the HOST)
Initial each item below After
_____1. I am the Parent and/or Legal Guardian of the infant Participant named above and am executing this form on behalf of the infant Participant in my capacity as parent and/or guardian and with the intent that this form be binding on myself and infant Participant for all legal purposes.
_______2. 1 Understand there are Inherent DANGERS, HAZARDS and RISKS, (collectively called RISKS) associated with Equine Activities and injuries resulting from these “RISKS” are a common occurrence.
_________3. I Acknowledge that the Inherent “RISKS” of Equine Activities mean those DANGEROUS conditions which are an integral part of Equine Activities, including but not limited to:
• The propensity of any equine to behave in ways that might result in injury, harm or death to persons on or around them and to potentially collide with, bite or kick other animals, people, or objects.
• The unpredictability of an equine’s reaction to such things as sounds, sudden movement, tremors, vibrations. unfamiliar objects, persons or other animals and hazards such as subsurface objects.
• The potential for other participant (s) to act in a negligent manner that might contribute to injury to themselves or others, such as failing to act within their ability or to maintain control over an equine.
__________4. I Freely Accept and Fully Assume All Responsibility for the Inherent “RISKS” and the possibility of personal injury, death, property damage or loss which might result from the infant being a Participant.
__________5. 1 Acknowledge that it remains my Sole Responsibility for the safety of the infant Participant and for the infant to Participate within his/her own limits.
__________6. In addition to consideration given for the infant to Participate in Equine Activity, I and my heirs, executors, administrators and assigns (collectively called my “Legal Representatives”) agree
• To Waive All Claims that I or the infant Participant might have against the “HOST”; and
• To Release the “HOST” from Any and All Liability for any loss, damages, injury, or expense that I. the infant Participant or our “Legal Representatives” might suffer as a result of the infant’s Participation due to any cause including any NEGLIGENCE ON THE PART OF THE “HOST”: and
• To HOLD HARMLESS AND INDEMNIFY THE “HOST” from any and all liability for property damage or personal injury to the infant Participant or to any third party which might result from the infant’s Participation.
Before signing this form I read it (as indicated by my initials above) and I stated that I understand it. I further state I am aware that signing this form, waives certain legal rights I and/or the infant Participant and/or our “Legal Representatives” might have against the “HOST”. SIGNED This ______________ day of____________________________ 2009.
Catherine Colwell – McAllister and Joseph McAllister_ of Corner Stone Farm
(Print Name of HOST Witness to signing & initialing)
______________________________________
(Signature Host Witness)
_______________________________________________
(Signature of Participant ) ______________________________________
(Signature of Parent/Guardian)
Do Not Sign until you Understand All Items Above