2012 SUMMER HORSEMANSHIP PROGRAM

STUDENT : AGE:

Payment Responsibility:

Name

Island address/phone #

Off-Island address/phone #

Fax:

ONE-WEEK SESSION $600.00 - Please check your appropriate week(s)

1. June 11 thru June 15 { } 7. July 23 thru July 27 { }

2. June 18 thru June 22 { } 8. July 30 thru August 3 { }

3. June 25 thru June 29 { } 9. August 6 thru August 10 { }

4. July 2 thru July 6 { } 10. August 13 thru August 17 { }

5. July 9 thru July 13 { } 11. August 20 thru August 24 { }

6. July 16 thru July 20 { }

Hours: 9:00 a.m. to 1:00 p.m.

$300 nonrefundable deposit required for each week. ALL BALANCES DUE JUNE 1^ST
(We do not bill and all balances to be paid before the beginning of the season.) Please mail payment to:

Arrowhead Farm

P O Box 102

West Tisbury, MA 02575

508-693-8831 Barn

508-693-6889 Fax

Waiver of Liability

I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of Arrowhead Farm. Recognizing the possibility of physical injury associated with horseback riding, accepting student/rider for the equestrian programs and activities ( the “program”, I hereby release, discharge and/or otherwise indemnify Arrowhead Farm, its personnel, including the owners of fields and facilities utilized for the programs, against any claims by or on behalf of the registrant as a result of the registrant’s participation in the Program.

Consent of Medical Treatment

I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions necessary to preserve life, limb or well-being of my dependent.

Please sign : Date: