North Country Horses 438 Clark Rd Gansevoort, NY

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1 North Country Horses 438 Clark Rd Gansevoort, NY Dear Parent, Thank you for your interest in North Country Horses Summer Horsemanship Camp. Our camp sessions run Monday through Friday on weeks listed below. Session 1, Day Camp July 6 - July 10 Session 2, Pony Pals & Advanced Rider Camp July 13 - July 17 Session 3, Day Camp July 20 - July 24 Session 4, Day Camp July 27 July 31 Session 5, Pony Pals & Advanced Rider Camp August 3 - August 7 Session 6, Day Camp August 10 - August 14 Session 7, Day Camp August 17 - August 21 Session 8, Day Camp August 24 - August 28 Day Camp is offered to any beginner through advanced rider, ages 5 and older. The rider must be 5 or older by their camp week. Riders will be grouped according to skill level during lessons. At the beginner level, riders will learn how to be safe and comfortable around the horses. Riders will learn the basics of riding including walk, halt, steering, and beginning to work at the posting trot. At the intermediate to advanced level, our campers will continue to work on skills learned in the past including; trotting on correct diagonals, balance of horse and rider, bending of horse, progress to or solidify canter or lope and work on identifying correct leads & jumping if riding level warrants. Camp will begin each weekday at 9:00 am and finish at 4:00 pm. Pony Pals is a shorter camp day for younger riders ages 4-6 years old. Riders will learn how to be safe and comfortable around the horses. Riders will learn the basics of riding including walk, halt, steering, and beginning to work at the posting trot. Camp will begin each weekday at 9:00 am and finish at 12:00 pm. Advanced Rider Camp is a full day camp for more skilled, current NCH riders. The focus will be on more advanced riding skills, including preparation for horse shows. Admission to this program is at the discretion of NCH trainers. Camp will begin each weekday at 9:00 am and finish at 4:00 pm. Riding lessons during all camps will be coordinated by an NCH trainer. Camp also includes unmounted sessions to cover training of key topics that every rider should know. These classes are designed to build our rider s self-confidence while teaching horsemanship and safety. Lessons concentrate on safety first, proper grooming, communication skills, body alignment, balance and an independent seat, which are the building blocks in becoming a good rider.

2 Of course we will also have lots of time for games and group activities providing fun and entertainment all week long. The camp week is structured to provide our campers with good horse sense while having lots of fun. Tuition Day Camp Advanced Rider Camp Pony Pals Camp $ per session $ per session $ per session A $50.00 non-refundable deposit must be paid at time of registration. All registration forms must be turned in with your deposit. The remaining balance for all sessions is due by June 15, Early drop off is available at 8:00 am at the rate of $75.00 per session, and must be paid with tuition by June 15, Campers who have not pre-registered for early drop off may not be dropped off before 9:00 am. Camp ends at 4:00 pm (12:00 for Pony Pals); all campers must be picked up at that time. Parents are required to provide their child with lunch; we will provide an afternoon snack and drink. We look forward to seeing you at Camp this summer! If you have any questions, please feel free to contact us via phone or . Thank you, The North Country Horses Summer Camp Team Amanda Vance, Director (518) Liz Russell, Registration & Billing (518) summercamp.nch@gmail.com

3 438 Clark Rd Gansevoort, NY SUMMER CAMP REGISTRATION Camper s Name: Nickname: Camper s Date of Birth: Gender Male / Female Session (s) attending: Day Camp Session 1 Advanced Rider Camp Session 2 Pony Pals Session 2 Day Camp Session 3 Day Camp Session 4 Advanced Rider Camp Session 5 Pony Pals Session 5 Day Camp Session 6 Day Camp Session 7 Day Camp Session8 July 6 - July 10, 9:00 am 4:00 pm July 13 - July 17, 9:00 am 4:00 pm July 13 - July 17, 9:00 am 12:00 pm July 20 - July 24, 9:00 am 4:00 pm July 27 - July 31, 9:00 am 4:00 pm August 3 - August 7, 9:00 am 4:00 pm August 3 - August 7, 9:00 am 12:00 pm August 10 - August 14, 9:00 am 4:00 pm August 17 - August 21, 9:00 am 4:00 pm August 24 - August 28, 9:00 am 4:00 pm Will camper be participating in the Early Drop off Program? Yes No Parent/Guardian (s) Name: Address: City: State: Zip Code: Phone: Home Cell Work Address: Parent/Guardian (s) Name: Address: City: State: Zip Code: Phone: Home Cell Work Address: Medical Information: Doctor s Name & Hospital Preference: Health Insurance Carrier: Policy Number: Allergies or other medical condition: R e g i s t r a t i o n F o r m P a g e 1

4 Riding Experience: Is your child currently taking riding lessons? If yes is your child a current NCH lessons student? If not where does your child currently ride? Yes No Yes No Please describe your child s riding experience: Riding achievement and/or goals: My child would like to ride: English Western Both We want to match your child with an appropriate horse or pony: Weight:. Height:. My child would like a North Country Horses Summer Camp Tee Shirt: (Please add $15.00) S M L XL How did you hear about North Country Horses? Parents, please return all forms with a $50.00 non-refundable deposit to: North Country Horses c/o Amanda Vance 438 Clark Rd Gansevoort, NY *** PLEASE NOTE: We do understand that situations occur however ALL camp deposits and payments are non-refundable and non-transferable, regardless of circumstances. You may only take advantage of 1 discount per session. Discounts are available for paying in full for camp prior to March 1st, 2015, for children participating in more than one session, for children who have siblings attending, as well as children who are current boarders or leasers. FOR OFFICE USE ONLY Registration Form Release Photo Release Tee Shirt Early Drop Off Discount: $ Early Sign Up Sibling Owner Deposit: $ Check # BALANCE DUE: Cash Date: R e g i s t r a t i o n F o r m P a g e 2

5 438 Clark Rd Gansevoort, NY Checklist for 2015 Campers Campers are required to wear long pants and close-toed shoes or boots with a heel upon arriving to camp each morning. Riding in shorts, capris, or sneakers is not allowed. We do recommend a change of clothes for the afternoon. Shorts and tennis shoes will be permitted for non-riding and non-horse handling time, but flip flops/sandals of any type are not allowed at any time. The following is a short checklist for each day: - Change of clothes - Bag Lunch (Snack for Pony Pals morning camp) - Water Bottle - Towel - Sunscreen - Helmet (if available if not, one will be provided) If you have any additional questions please feel free to contact us anytime. Below is a list of places that will be able to assist you in purchasing appropriate equipment for camp, including boots and a helmet. English: Bits N Pieces Tack Shop 206 Gansevoort Rd, Gansevoort, NY (518) Cheshire Horse of Saratoga 402 Geyser Road Saratoga Springs, NY (518) Western: Bits N Pieces Tack Shop 206 Gansevoort Rd, Gansevoort, NY (518) Walkers Home Farm and Tack 5565 U.S. 4 Fort Ann, NY (518)

6 438 Clark Rd Gansevoort, NY Photo Release Form I grant permission to North Country Horses to take and use photographs of my child for their website, Facebook page, brochures, flyers, and advertisements, without notifying me. I also agree to let my child be photographed for their camp projects and their photo albums. My signature below releases North Country Horses from any copyright infringement. I hereby waive any right to inspect or approve the photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photographs. I hereby agree to release and hold harmless North Country Horses from and against any claims, damages or liability arising from or related to the use of the photographs, including but not limited to any re-use, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in production of the finished product. Child s Name: Parent/Guardian Name: Signature of Parent or Guardian DATED this day of, 2015.

7 EQUINE ACTIVITY RELEASE AND WAIVER OF LIABILITY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT Read Carefully I agree to the following agreement with NCH as a condition for allowing my voluntary participation or that of my child or legal ward in Equine Activities. A. SCOPE: This agreement shall be legally binding upon the below identified person, and if a minor, upon the parents and legal guardians thereof, including any heirs, estate, assigns, all minor children and personal representatives and it shall be interpreted according to the laws of the state of New York. B. DEFINITIONS: The term "NCH" shall refer to Amanda Vance, North Country Horses, its owners, officers, employees, agents, leaders, instructors, contractors, representatives or volunteers. The term "HORSE" herein shall refer to all equine species. The term "EQUINE ACTIVITY" shall refer to riding or otherwise handling, grooming, feeding, petting or other interaction with or within proximity of a horse or horses, whether from the ground or mounted. The term "PARTICIPANT" herein refers to a person who is engaged in an Equine Activity as defined above. The terms "I", "ME", "MY" shall refer to the above registered rider and the parents or legal guardians if a minor. C. ACTIVITY RISK CLARIFICATION: Equine activities are inherently dangerous. Inherent risks are always present in equine activities despite all safety precautions, and may include collisions with trees, people, and other animals or objects, stopping short, changing directions or speed at will, bucking, rearing, kicking, biting, or running from danger. Horses are sentient creatures capable of memories and emotions. As such, a horse may exhibit unpredictable reactions to handling, riding, external stimulus, noises, people, other horses, objects and machinery. If a horse is frightened or provoked it may divert from it's training and act accordingly to its natural survival instincts. These and other reactions can occur without warning. Horses are powerful creatures, and even the most docile horses and those without a history of causing injury have the potential to be dangerous to people, property and other animals that are on, near or around them. A horse may react in a dangerous manner regardless of the equines previous training and past performance. These reactions could cause a rider, handler or observer to suffer serious bodily injury, which could result in severe impairment or even death. D. PARTICIPANT INFORMATION W a i v e r P a g e 1

8 Name: DOB: Parent(s)/Legal Guardian Name Address: E. LIABILITY WAIVERS AND RELEASE, AND EXPRESS ASSUMPTION OF RISK. As lawful consideration for NCH allowing me to engage Equine Activities, now or in the future, and with full knowledge and appreciation of the risks associated with equine activities, I freely and voluntarily agree to assume the risks involved in any aspect of Equine Activities. I agree to assume full responsibility for any and all bodily injuries or damages which I may sustain at any time when engaging in Equine Activities or while participating on or near NCH properties or with a NCH Trainer or Instructor. The term "damages," means, for example, medical expenses, losses incurred because of bodily injuries or property damages, and/or personal property damages. To the fullest extent allowed under New York law, I, for myself and for my heirs, administrators, personal representatives or assigns, release and discharge Amanda Vance and NCH, and their respective officers, directors, employees, agents, assistants, representatives, assigns, and others acting on their behalf of and from any and all claims, demands, damages, actions, omissions, suits, or causes of action (present and future), whether the same is caused by the ordinary negligence of these parties or not. I hereby agree to assume full responsibility for any risk of damages, bodily injuries, or other injuries or losses, whether known or unknown, anticipated or unanticipated, resulting from or arising out of engaging in any or all of the Equine Activities at any location. F. WAIVER AND LIABILITY RELEASE PERTAINING TO EQUINE(S). With respect to each equine that I own, lease, ride, handle, use, or provide for any of the Equine Activities (whether or not I am the one who is working with the equine), I agree to release and discharge Amanda Vance and NCH, and their respective officers, directors, employees, agents, assistants, representatives, assigns, and others acting on their behalf, of and from all claims, demands, actions, or causes of action (whether they occur now or in the future, and whether they are known or unknown), resulting from ordinary negligence of Instructor or of others associated with Instructor. This waiver and release is intended to apply at all times before, during, or after the Equine Activities that take place at any location that may result in injury, loss, or damage to this/these equine(s) and that may accrue from any cause whatsoever, including accidents, illnesses, theft, running away, and/or injuries that may occur before, during, or after any of the Equine Activities (except if injury or damage was directly caused by Instructor's gross negligence or willful and wanton misconduct). G. N.Y. GENERAL OBLIGATIONS LAW INAPPLICABLE. I understand and agree that the New York General Obligations Law 5-326, which deems certain waivers/releases void when used in connection with a "place of amusement or recreation or similar establishment," does not apply to this Agreement and to my participation in any or all of the Equine Activities. The Equine Activities take place at a private facility that engages in instruction and educational activity. H. INDEMNITY AGREEMENT. I also agree to indemnify and hold harmless Amanda Vance and NCH, and their respective officers, directors, employees, agents, assistants, representatives, assigns, and others acting on their behalf against all damages which are sustained or suffered by myself or my minor children including legal wards including any and all W a i v e r P a g e 2

9 injuries or damages whatsoever that I may cause, directly or indirectly, while engaging in any Equine Activity at any time and at any location. This indemnity agreement shall apply regardless of whether or not the injury, death, or damage incurred by others is caused by the ordinary negligence of Amanda Vance and NCH, and their respective officers, directors, employees, agents, assistants, representatives, assigns, and others acting on their behalf and shall include reimbursement of NCH's reasonable attorney s fees. I. RIDING HELMETS. New York State Law requires all persons under the age of 18 years old to wear a helmet, which meets or exceeds ASTM Fl 163 Equestrian Standard while mounted on a horse. NCH strongly recommends the same helmet be worn by persons under the age of 18 while engaged at any time in Equine Activities. NCH has helmets available for use by persons under the age of 18. If I am the parent of guardian of a person under the age of 18,1 agree to ensure a helmet is worn by them at all times when mounted in compliance with the law. If I am a Participant at least 18 years old, I agree to be fully responsible for my own safety at all times while engaging in any Equine Activity at any time and at any location. NCH has advised me that, for my own protection, I should purchase and wear a helmet, which meets or exceeds ASTM Fl 163 Equestrian Standard for use when riding or otherwise participating in Equine Activities. I am NOT relying on NCH to provide a certified helmet for me, to check any helmet or helmet strap that I may wear, or to monitor my compliance with this suggestion at any time - now or in the future. J. LAW / MODIFICATION. This Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement is governed by New York law and is intended to be as broad and inclusive as the law permits. Should any clause in this document conflict with the law, only that clause will be void and the remainder of this document shall stay in full force and effect at all times, now and in the future. This document can only be modified in a written document that is signed by both NCH and me. K. BREACH / DISPUTES / CHOICE OF LAW. If I breach any part of this Release and Waiver of Liability, Instruction Agreement, Assumption of Risk, and Indemnity Agreement, I agree to pay the attorney fees and court costs related to such breach incurred by Instructor and/or persons directly affiliated with Instructor. It is also mutually agreed that any disputes arising under this Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement, or any activities that are undertaken pursuant to it, shall be litigated in a court of proper jurisdiction located in or nearest to Saratoga County, New York. I agree that this is a convenient location. SIGNATURE: DATE: PRINTED NAME: SIGNATURE OF NCH: DATE: PRINTED NAME: W a i v e r P a g e 3

10 Emergency Contact & Treatment Form PARTICIPANT NAME IN CASE OF EMERGENCY, NOTIFY: Name Relationship Address Phone Phone home/work/mobile home/work/mobile ALTERNATE EMERGENCY CONTACT: (in the event that the person above cannot be reached) Name Relationship Address Phone Phone home/work/mobile home/work/mobile MEDICAL INFORMATION Health Insurance Carrier Policy # Insurance Phone Physicial Phone Address Date of Last Tetanus Shot Allergie(s) or special medical condition(s) AUTHORIZATION TO CONSENT TO TREATMENT (Optional) To be filled in and signed by adult participant, or parent(s) or legal guardian(s) of a minor participant, whose medical insurance is carried by the above named health insurance policy, as agent(s), to consent to any x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care deemed advisable and rendered by any licensed physician, licensed emergency medical technician, or surgeon, in a remote location, in an office or in a licensed hospital. This authorization is given in advance of any required care to empower the agent(s) to give consent for such treatment as the health-care giver may deem advisable. This authorization shall remain effective indefinitely, unless revoked in writing. Participant's Signature: Date: Parent or Legal Guardian: Date: (For Participants Under 18)

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