MJM Summer Camp 2017 Registration Form and Waiver
NOTE YOU WILL NOT RECEIVE A CONFIRMATION E-MAIL UPON FORM COMPLETION, so if you'd like to confirm that the form went through, email daisymeadowsequestrian@gmail.com

The information collected in this form will be used for internal records and scheduling ONLY. We will NOT distribute this information to any third parties.

Summer Riding Camp 2017 for ages 5 – 15 runs for the following sessions:
Week 1- July 3- July 7, 2017
Week 2- July 10-July 15, 2017
Week 3- July 17-July 21, 2017 THIS WEEK FULL
Week 4- July 24- July 18, 2017
Week 5- July 31-August 4, 2017
Week 6- August 7-11, 2017
Week 7- August 14-18, 2017 THIS WEEK FULL
Week 8- August 21-25, 2017
Week 9- August 28 - September 1, 2017

Payment: No deposit required. Payment to be made on the first day of camp, when dropping off camper for the day. Cost is $250 per week plus HST. We accept cash or cheque ONLY for payment.

Before and After Care is available for $5 per hour. Please indicate on this form in you require before or after care.

About our riding instructors: All of our riding instructors have achieved a minimum of Equine Canada Rider Level 6, a national standard required to become a certified riding instructor for beginners (see www.equinecanada.ca for more information).

What you need: Wear long, close fitting pants (no shorts), rain boots (no running shoes), and thin gloves (garden gloves are fine). Bring water as well to stay hydrated, lunch, and snacks. We provide helmets. Campers may want to bring a change of clothes, as while camp is conducted inside on rainy days, we sometimes play water games if it is hot.

Location: The riding school is located at 6095 Dickenson Rd Eeast, Hamilton, Ontario. However the entrance to the riding school is off Nebo road. It is the second entrance on the right if you are heading south on Nebo, past Dickenson. The barn is immediately on the right hand side as you drive in, and you'll see a sign for the riding school. If you get lost just ask anyone for the riding school. Please arrive 30 min before the lesson, to allow time to fill out a registration form and for tack up.

Phone Daisy 905-745-4773 or email daisymeadowsequestrian@gmail.com with any additional questions

See http://www.mjmequestriancentre.com/camps.html for more information including daily schedule

Rider First Name
Your answer
Rider Last Name
Your answer
Rider age
Your answer
Parent/Guardian First Name
Your answer
Parent/Guardian Last Name
Your answer
Rider/Parent/Guardian Phone
Format: (905) 745-4773
Your answer
Rider/Parent/Guardian Email
Your answer
Emergency Contact First Name
Your answer
Emergency Contact Last Name
Your answer
Emergency Contact Phone
Format: (905) 745-4773
Your answer
Emergency Contact 2 First Name
Your answer
Emergency Contact 2 Last Name
Your answer
Emergency Contact 2 Phone
Format: (905) 745-4773
Your answer
Which sessions would you like to register for? Note: *we only offer registration for the full week for summer camp 2017; **Week 3- July 17- July 21, 2017 FULL- waitlist only as of June 28 2017, ***Week 4- July 24- July 28, 2017 FULL waitlist only as of June 28 2017
Required
Previous Riding Experience
Do you require before and/or after care (drop off before 9am or pick up after 4pm)? If so please specify:
Your answer
I understand that I will have to pay for before and after care at a rate of $5 per hour, if I drop off my child before 9 am or pick up my child after 4pm
I understand that no deposit is required, and that full payment is to be made on the first day of camp, when dropping off the rider for the day. Cost is $250 per week plus HST. We accept cash or cheque ONLY for payment. We do not accept any other form of payment and do not offer discounts.
Required
Please detail any disability or medical conditions that may affect the rider's ability to ride. This may include but not be limited to any back problems, any conditions which can affect balance or cause blackouts/loss of consciousness, allergies, anxiety, dislexia, and/or any learning disabilities
Your answer
Is there anything about the rider we should know that would enhance their experience at MJM?
Your answer
WAIVER AND RELEASE OF LIABILITY (Attaching to and forming part of Policy #EA00091) In consideration of being allowed to participate in equestrian sport of MJM Equestrian Centre, including related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1) The risk of injury from the activities involved in equestrian sport are significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist; and, 2) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participations; and, 3) I willingly agree to comply with the rules and customary terms and conductions for participation. If however, I observe an unusual significant hazard during my presence of participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS MJM Equestrian Centre and Daisy Meadows Equestrian, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of the premises, used to conduct the equestrian sport (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss of damage to person or property, WHETHER CAUSE BY THE RELEASEES OR OTHERWISE. ..................................................................................FOR PARTICIPANTS OF MINORITY AGE (Under Age of 18 at time of Registration): This certifies that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in the equestrian sport described above.
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