Kensington Stables Inc. 51 Caton Place, Brooklyn, NY 11218 718-972-4588 www.kensingtonstables.com Email: email@example.com 2013 PONY CLUB RESERVATION FORM RIDER INFORMATION Name ____________________________________ Age ______Date of Birth__________ Approx.
Weight______ Allergies ________________________ Sibling ___________________________________ Age ______Date of Birth__________ Approx.
Weight______ Allergies __________________________ Address ___________________________________________________________________ City______________ State_____ ZIP_________ Parent email: ________________________ Home Phone __________________ Work __________________ Cell __________________ Other info you’d like us to know about your child: ___________________________________________________________________________ Previous Riding Experience ___________________________________________________________________________ EMERGENCY CONTACTS Name________________________________ Relationship to Child ____________________ Daytime phone: ________________________ Cell phone: ____________________________ Name________________________________ Relationship to Child ____________________ Daytime phone: ________________________ Cell phone: ____________________________ Check the week(s) you would like your child to participate & circle payment amount: [ ] Spring Break: Mar 25-29 Early Pony $350 by Feb 15; after Mar 15: $375 [ ] Summer Wk 1: Jun 24-29 Early Pony $350 by Feb 158; by Mar. 15: $375; Reg.
Fee: $400 [ ] Summer Wk 2:Jul 1-Jul 5* Early Pony $280 by Feb 15; by Mar. 15: $300; Reg.
Fee: $320 [ ] Summer Week 3: Jul 8-Jul 12 Early Pony $350 by Feb 15; by Mar. 15: $375; Reg.
Fee: $400 [ ] Summer Week 4: Jul 15-20 Early Pony $350 by Feb 15; by Mar. 15: $375; Reg.
Fee: $400 [ ] Summer Week 5: Jul 22-26 Early Pony $350 by Feb 15; by Mar. 15: $375; Reg.
Fee: $400 [ ] Summer Week 6: Jul 29-Aug 2 Early Pony $350 by Feb 15; by Mar. 15: $375; Reg.
Fee: $400 [ ] Summer Week 7: Aug 5-9 Early Pony $350 by Feb 15; by Mar. 15: $375; Reg.
Fee: $400 [ ] Summer Week 8: Aug 12-16 Early Pony $350 by Feb 15; by Mar. 15: $375; Reg.
Fee: $400 [ ] Summer Week 9: Aug 19-23 Early Pony $350 by Feb 15; by Mar. 15: $375; Reg.
Fee: $400 [ ] Summer Wk 10: Aug 26-30 Early Pony $350 by Feb 15; by Mar. 15: $375; Reg.
Fee: $400 * Please note there is no camp on July 4th.
Do you need [ ]early drop off [ ] late pick-up? $15/hour x days________ = $__________ Would you like to purchase a helmet? If yes, check size & color.
Size: [ ] small [ ] medium [ ] large Standard color- $30, Fashion color- $35 Standard colors: [ ]blue [ ]green [ ]black [ ]white [ ]gold [ ]silver [ ]purple Fashion colors: [ ]Blue Mist [ ]Sunset Pink [ ]Lavender [ ]Bronze [ ]Citron Allow Four Weeks for ordering equipment, so make your reservation well in advance.
Subtotals: Pony Club Week(s)________+ Drop-off/Pick-up_______Equipment________= TOTAL AMOUNT FOR YOUR RESERVATION: $________ KENSINGTON STABLES, INC.
HORSE REN TAL/RIDING AGREEM ENT-WAIVER O F LIABILITY AND ASSUM PTION OF RISK Please print the name, address, telephone number and age of rider and, if a minor, parent or guardian ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Initial each paragraph: ______ A.
NAT URE OF A GRE EM ENT.
In consideration of the services Kensin gton St ables, Inc., its owners, agents, emp loyees, volun teers and all o ther person s or entities acting in any capac ity on its behalf (all hereinafter referred to as “ Kensington Stables”), I hereby agree to hire from Kensington Stables a horse, tack and equipment for the purpose of horseback riding.
I further agree to release and discharge Kensington Stables, on behalf of myself, my spouse, dom estic partner, children, parents, heirs, assigns, personal re presentative and estate, fro m any liability that ma y arise therefrom as set forth belo w. ______ B.
NOT A PLA CE O F AM USEM ENT.
I understand that Kensingto n Stables is a livery stable, and not a place of recreation or am usement.
It’s sole purpose is the board ing and rental of horses.
Ancillary services, including, but not limited to, riding lessons, trail rides and pony rides are provided by instructors and guides who are independent contractors for whom Kensingto n Stables is not responsible. ______ C.
AGR EEM ENT S COP E AN D DE FINIT IONS .
This Horse Rental, Waiver of Liability and Acknow ledgment o f Risk Form (this “Agreem ent”) shall be leg ally binding on me, my spo use, dome stic partner, children, parents, heirs, assigns, personal representative and estate.
The term “HORSE” as used herein shall refe r to all equine sp ecies.
The term “HO RSEB ACK R IDING ” as used he rein shall refer to riding or otherwise handling horses, whether from the ground or mounted.
The term “RIDER” as used herein refers to any person who rides a horse mounted o r who otherwise handles o r comes near a horse from the gro und.
The terms “I”, “M E” and “M Y” as used herein shall refer to any perso n signing this Agreem ent. ______ D.
RISK CLA SSIFIC ATIO N.
I understand horseback riding is an INHERENTLY DANGEROUS ACT IVITY , and there ar e numero us known a nd unknow n risks in this activity, desp ite all customar y safety precautions.
I understand such risks cannot be eliminated without jeopardizing the essential qualities of horseback riding.
I acknowledge horseback riding, including instruction, could result in serious physical or emotiona l injury, or other damage to myself, third pa rties, and my o wn or other s’ property .
Such injuries can be severe, requiring more hospital days and resulting in more lasting residual effects, than injuries resulting from less dangerous activities. ______ E.
ACK NOW LEDG ME NT O F RISK S.
I acknowledge the known and inherent risks of horseback riding include, but are not limited to, the following, many of which can scare a horse, cause it or its rider to fall or react in an unsafe manner: 1) weather conditions, inc luding temp erature, wind and wind d riven obje cts, rain and snow, lightning, thunder, fog and excessive heat and sun, some of which may change quickly; 2) hypotherm ia (being too cold) and hypertherm ia (being too hot); 3) trail con ditions, includin g icy, snowy, muddy, slippery and loose footing, water crossings, falling rocks, branches and timber, fences, natural and man-made chan ges in the landscape and m otorized/non-motorize d traffic; 4) contact with plants, insects, reptiles, dogs, and other wild or domestic animals reptiles which may walk, run or fly near, or may bite or sting, a horse or rider; 5) improper first aid, emergency treatment or other attempted rescue services, and the unavailability of life sa ving services o r immediate medical atten tion in the case o f injury; 6) unava ilability of telephone or other communication services to summon aid or for other purposes, 7) my own physical condition and or omissions; 8) my own and other riders’ attempts to exceed riding skills and/or riding in a careless, reck less or impro per mann er; 9) injury to a h orse; 10) th e failure of a ho rse to respo nd to a ride r’s comma nds; 11) un predictibility of a horse’s beh avior; includin g, but not limited to, stopping suddenly, _________________________________________ _________________________________________ _________________________________________ _________________________________________ Page 1 of 3 PDF Created with deskPDF PDF Writer – Trial :: http://www.docudesk.com swerving, spinning becoming “spooked,” bucking, suddenly accelerating, kicking, dipping its neck or body or grazing; 12 ) my own failure or that of other riders to follow the safety guidelines and commands/instructions of independent contractors giving lessons or guiding trail rides; 13) improper use of equipme nt; 14) inad equate rep air or main tenance of Kensington Stables’ facilities and equipment; 15) manufactur ing or other d efects, both ap parent and latent, in equipm ent supplied or used by Kensington Stables; 16) vehicular or pedestrian accident while riding a horse on public streets or roadways, 17) vehicular or pedestrian accident while being transported or walking to or from Kensingto n Stables or any of its staging areas; 18) error or negligence on the part of independent contractors using the facilities of Kensington Stables or on the part of employees of Kensington Stables, including insufficient instruction or assistance. _____ F.
ASSU MP TION OF R ISK.
I knowingly an d voluntarily assu me all of the risks in herent in enga ging in horseback riding, including those that may not be specifically enumerated herein.
NAT URE OF K ENSIN GTO N STA BLE S’ HO RSES .
Although Kensingto n Stables chooses its rental horses for their calm dispositions and sound basic training, no horse is completely safe.
Horses are larger, more powerful an d faster than a h uman.
If a ride r falls from a hor se to the grou nd, it will generally be a distance of 3-1/2 to 5-1/2 feet, and the impact may result in injury to the rider.
If a horse is frightened or provoked, it may divert from its training and act according to its natural survival instincts, which include, but are not limited to: 1) stopping short; 2) changing direction or speed at will; 3) shifting its weight; 4) bucking, rea ring or kicking ; 5) biting; and 6 ) running from danger.
D ue to the unp redictability of a h orse’s behavior , Kensington Stables makes no warranty of any kind, exp ress or implied, is made as to hab its, disposition, suitability, nature or physical condition of any horse. _____ ______ H.
RIDE R RE SPO NSIB ILITY .
I understand that upon mounting a horse and taking up the reins, the rider is in primary control of the horse.
The rider’s safety largely depends upon his/her ability to carry out instructions and to remain ab oard the m oving anima l.
I agree not to attempt to ex ceed my o wn riding skills or ride in a re ckless mann er.
I understa nd each rid er is primarily res ponsible fo r his or her ow n safety. ______ I.
MY RIDIN G SK ILLS.
I have truthfully and accurately disclosed to Kensington Stables the level of my riding expe rience and skills: Novice _ ___ B eginner __ __ Interm ediate __ __ Exp erienced _ ____.
I understand that the level of da nger increas es in direct pro portion to th e lack of riding experienc e. ______ J.
CAR RY-O N OB JECT S/NO ISES.
I understand riders must not carry loose items on rides or at lessons which may fall, blow away, flap in the wind, bounce or make sharp noises, thereby possibly scaring a horse.
Suc h items include , but are not lim ited to: 1) unse cured cam eras; 2) hats o r helmets not se curely fastened under the chin; 3) toys; 4) purse s and handbags.
I und erstand riders must not make sharp noises, such as screaming or yelling, nor may any rider play any radio, ipod, cd player, tape player or similar device, all of which which may scare a horse or divert the rider from the full concentration required. ______ K.
SAD DLE G IRTH S – NA TUR AL LO OSE NING .
I understand saddle girths (saddle fasteners around horse’s belly) may loosen before or during a ride.
If a rider notices such loosening, he or she must alert the nearest guide, instructor or wrangler as quickly as possible so action may be taken to avoid slippage of the saddle and a potential fall from the horse. ______ L.
CON SENT TO M EDIC AL TR EATM ENT.
I understand that Kensington Stables is not qualified to render first aid and will not do so in the event of any accident.
In the event Kensington Stables is able to summon assistance, I co nsent to the calling of an ambu lance or an EMT and any em ergency, ho spital, medical care or surgical diagnosis or treatment to be rendered to me as found advisable, for any injury that may arise from participation in activities with Kensington Stables.
I also understand and agree that I am solely responsible for all applicable charges for such ambulance, medical treatment, evacuation and rescue costs. _____ ______ M.
PRO TECT IVE H EAD GEA R.
I have bee n offered pr otective hea dgear by Kensington Stables, and understand that wearing such headgear while mounting, riding, dismounting and otherwise being around Page 2 of 3 PDF Created with deskPDF PDF Writer – Trial :: http://www.docudesk.com horses may, but is not guaranteed to, prevent or reduce the severity of some head injuries.
I understand that Kensington Stables’ protective headgear may not be a perfect fit for each rider’s head, and that once provided, I will be respo nsible for securing such headgea r at all times.
Kensington Stables makes no representations or warranties concerning the condition or quality of the headgear it has offered me. ____ Yes I would like to wear protective headgear. ____ No.
I decline to wear protective headgear. ______ N.
LEGA L AC TION S CO NCE RNIN G AG REEM ENT.
Should Kensingto n Stables or anyone acting on its behalf be req uired to incu r attorney’s fees an d costs in an ac tion or pro ceeding b rought by m e that is barred by this Agreement, I agree to indemnify and hold them harmless for all such fees and costs.
I agree that substantive N ew York State law (and not only conflict o f law rules) rather th an the law of an y other state or jurisdictio n shall be ap plied in any leg al action involv ing the interpre tation, validity and /or enforce ability of this Agreement, and that any legal action resulting from my participation in this activity shall be brought only in Kings C ounty of Ne w York S tate.
In the event tha t any portion o f this Agreeme nt is deemed invalid or unenfor ceable, all oth er portions of this Agreem ent shall remain in full force and e ffect. ______ O.
WA IVER OF L IABIL ITY/C OND ITION S OF P ART ICIPA TION .
I hereby voluntarily release, forever discharge and agree to indemnify and hold harmless Kensingto n Stables from any and all claims, demand s, or causes o f action which a re in any way co nnected w ith my participa tion in any equ estrian activity or use of Kensington Stables’ horses, equipment or facilities, including any such claims which allege negligent acts o r omissions b y Kensington Stables.
I expressly agree that, except in the event of Kensington Stable’s gross negligence or willful and wanton misconduct, I will not initiate a lawsuit nor bring any claim s, demand s, or causes o f action against Kensingto n Stables for any economic or noneconom ic losses due to bodily inju ry, property d amage, sustain ed by me o r my minor c hildren in relatio n to the premise s and ope rations of Kensin gton St ables, to include while riding, handling, or otherwise being near horse s owned b y, or in the care o f, Kensington Stables, whether on o r off the prem ises of Kensington Stables.
I further expressly agree and promise to accept and assume all of the risks existing in horseback riding.
My participation in this activity is purely voluntary, and I elect to participate in spite of the risks of participating in horseback riding. ______ P.
SIGNER STATEMENT OF AWARENESS AND UNDERSTANDING By signing this document, I acknowledge that if I am hurt or any property is damaged during my participatio n in this activity, I may b e found by a court of law to h ave waived my right to main tain a lawsuit against Kensingto n Stables on the basis of any claim which I have released herein.
I have had sufficient oppor tunity to read this e ntire docum ent and ask a ny questions tha t I may have.
I ac knowledg e that I would have alerted Kensingto n Stables if my comprehension of the English la nguage wa s not sufficient to fully appreciate this Agreement’s provisions.
I have read and understand it, and I agree to be bound by its terms on this and every occasion hereafter upon which I may rent, borrow or otherwise use a horse from Kensington Stables.
Dated: Brooklyn, New York 20___ Signature of Rider: ____________________________________________________ Print Name: __________________________________________________________ Signature of Parent/Guardian: ____________________________________________ Print Name: __________________________________________________________ WITNESSED:__________________________________________ Print Name: _________________________________________
Read more about Livery Stable : I understand that Kensingto n Stables is a livery stable….: