Name

This field is for validation purposes and should be left unchanged.

Please complete the registration form, horseback riding questionnaire, liability release, and medical emergency forms.
Love Creek Farm must receive all paperwork at least two weeks prior to your camper’s first day of camp.

A confirmation email will be sent upon receipt of your registration.

Camper's Name(Required)

First Last

Parent or Guardian Name(Required)

First Last

Allergies(Required)

List all your allergies here

Special Needs(Required)

List all your allergies here

Your Address(Required)

Street Address Address Line 2 City ZIP Code

Telephone(Required)

Cell Phone(Required)

Emergency Contact Name(Required)

First Last

Relation(Required)

Your relation to your Emergency Contact Name

Your Email Address(Required)

Email Address Confirm Email Address

Parent Email(Required)

Email Address Confirm Email Address

Persons Authorized for Drop Off and Pick Up(Required)

Love Creek Farm Summer Riding Camp
Horseback Riding Questionnaire

Please fill out this questionnaire to help us prepare for your time at camp. This form is necessary so we can match horse and rider appropriately and therefore give campers a great time at camp.
Thank you!

Camper's Name(Required)

First Last

Height(Required)

Enter your height

Weight(Required)

Please note- our horses have a 150 lb. weight limit

Riding Experience(Required)

BRAND NEW Never been on a horse, nervous around horses, and/or may need support to sit balanced in saddle walking, lead line

BEGINNER Ridden a horse less than 5 times, little to no experience, walk and trot

ADVANCED BEGINNER Ridden a horses more than 5 times, can walk/trot/canter

INTERMEDIATE Taken more than 5 horseback riding lessons and performs basic riding skills, walk/trot/canter, small single jumps) Advanced (takes/has taken horseback riding

ADVANCED Takes/has taken horseback riding lessons consistently, can walk/trot and perform basic riding skills, confident and comfortable when riding/working with horses, walk/trot/canter, small jump courses

Please describe any riding experience you have or anything we should know about your experience with horses.(Required)

Please note, all horses and ponies are assigned by the Camp Head Trainer at their discretion. We take into consideration the age/weight/height/experience of campers to ensure a safe and enjoyable time at camp.

Photo Consent and Release

Do you consent?(Required)

YES! I’ll smile for the camera. Feel free to put my picture anywhere on your website, social media, printed materials or other advertising.

NO I'm camera shy! Please do not take or post pictures of me anywhere.

Camper's Name(Required)

First Last

Parent or Guardian Name(Required)

First Last

Parent or Guardian Signature(Required)

Love Creek Farm Summer Riding Camp

Liability Release and Agreement for this Facility and Program

Love Creek Farm, which for this agreement, is synonymous with the property located at 20033 John J. Williams Hwy.

In consideration of being permitted to ride, interact with horses and ponies, take lessons, participate in special functions, which include traveling to and from special events, clinics, trail rides, special sessions, birthday parties, pony rides, equine assisted activities, volunteering and related events and activities; I hereby:

Understand that horse-back riding is a high risk sport and I understand the inherent dangers of riding or being around horses and am participating at my own risk. Serious injury may result from using this facility. I am willing to accept the risk of working with/on horses.
Hold Love Creek Farm volunteers harmless for any and all injuries or illness incurred by myself, my minor children and any others that accompany me on said property. I shall bring no claims, demands, actions, causes or action and/or litigation against Love Creek Farm and/or its associates or owners as previously stated for any loss due to bodily injury or death sustained by me, my minor children, legal ward, or horse(s) in relation to the premises and operation of this facility., which includes riding, handling, or being near horses and/or other animals.
Understand and agree that Love Creek Farm is not responsible for any act, occurrence, or element of nature that can scare, endanger or cause harm to a horse, causing it to react in an unsafe manner.
Acknowledge that I am familiar with horse riding and understand the rules governing special activities and the importance of following Love Creek Farm Rules.
Agree that prior to any horse related activity, I will inspect horses, ponies, equipment, facilities, etc., and if I believe anything to be unsafe or beyond my capability, I will immediately notify the person in charge and refuse to participate.
Acknowledge and fully understand that I will be engaged in an activity that might result in serious injury including permanent disability or death, and severe social and economic loss. Not only by my action, inaction, or negligence, but also by the action, inaction and negligence of others, the rules of the sport/activity, or conditions of the premises or equipment used. Further, I acknowledge that there may be other risks not known to me or foreseeable at this time.
I am aware of the risks involved with horseback riding and I assume these risks and accept personal responsibility for the damages following such injury, permanent disability or death.
Understand that no pets other than the animals of Love Creek Farm will be allowed on the property.
Have checked with my child’s physician and my son/daughter has been given a clean bill of health to participate in horse related activities OR has specific written permission by the child’s physician and/or attending health care professional(s) to participate in horse related activities.
Understand that Love Creek Farm cannot allow a person or persons to participate in any horse-related activity(s) if they have used: alcohol, controlled substances or any mood/mind altering substances. This includes illegal drugs, as well as prescription medication, if use of said medication in any way impairs a person’s alertness or perception.
Understand and agree that anyone using this facility and/or parent/guardian will repair or reimburse Love Creek Farm for all expenses which include materials and time in the event of any damage to equipment, jumps, arenas, or any part of the property that is damaged by their horse(s) or themselves.
Am aware that inhumane treatment of the horse(s) or repeated unsafe acts will immediately void all agreements and I will forfeit any fees and rights to access this center.
Understand that the stable owner shall not be liable for an injury to the horse(s) or damage to any property should the said horse(s) escape from the enclosure or while on the property.

I have read this warning, waiver and release, and understand that I give up substantial rights by signing it, and knowing this I sign it freely and voluntarily agree to participate and/or have my minor children participate, knowing these risks and conditions involved and do so of my own free will.

Name of Participant(Required)

First Last

Parent or Guardian Name(Required)

First Last

Parent or Guardian Signature(Required)

Date(Required)

CAMPER MEDICAL EMERGENCY INFORMATION

In the event of an emergency, contact:

Name(Required)

Relation(Required)

Phone(Required)

Name

Relation

Phone

CONSENT PLAN

In the event that emergency medical aid/treatment is required due to illness or injury during center activities, or while on the property of the agency, I authorize Love Creek Farm to:

Secure and maintain medical treatment and transportation if needed.
Release participant records upon request to the authorized individual or agency involved in the medical emergency treatment.

This authorization includes x-ray, surgery, hospitalization, medication and any treatment procedure deemed “life saving” by the physician. This provision will only be invoked if the person(s) above is unable to be reached.

Signature

Date

Parent or legal guardian, if under 18

NON-CONSENT PLAN

I do not give my consent for emergency medical treatment/aid in the case of illness or injury during center activities or while on the property of the agency. In the event emergency treatment/aid is required, I wish the following procedures to take place:

Non-Consent Plan Procedures

Signature

Date

Parent or legal guardian, if under 18

LOVE CREEK FARM RELEASE AND HOLD HARMLESS AGREEMENT

No student will be accepted for equine assisted activities and/or horsemanship instruction and no volunteer accepted for service at Love Creek Farm until this form has been READ, UNDERSTOOD, COMPLETED AND SIGNED by the parent(s) or guardian(s) of a minor or, if the student or volunteer is of legal age and sound mind, by the student or volunteer.

Although participation in the program is under strict supervision and every effort is made to avoid injury or accident, the undersigned acknowledges the inherent risks involved in riding, driving, and working around horses. This includes bodily injury from horseback riding or driving or being in close proximity to horses. Among other risks, both horse and rider can be injured during normal use or in competition and schooling.

In order to provide this valuable service, NO LIABILITY can be accepted by Love Creek Farm or any of the organizations or persons connected with the above named facility.

IN CONSIDERATION for the privilege of riding, driving and/or working around horses at Love Creek Farm as parent(s), or guardian(s) of the named minor, jointly or severally, do hereby agree to release, hold harmless and indemnify Love Creek Farm, its officers, directors, trustees, agents, employees, representatives, successors and assigns from all manner of liability, loss, costs, claims, demands and damages of every kind and nature whatsoever.

Including but not limited to reasonable attorney’s fees, which the undersigned or said minor may now or in the future have against Love Creek Farm, its officers, directors, trustees, agents, employees, representatives, successors and assigns, on account of any accident, damage, injury or illness, physical or mental condition, known or unknown, to the undersigned or said minor, or the treatment thereof, arising as a result of, or in any way connected to, acts or incidents occurring at or relating to Love Creek Farm, its officers, directors, trustees, agents, employees, representatives, successors or assigns, including but not limited to their negligence or gross negligence in rendering the services described above or in any way incidental thereto.

I have carefully read this agreement and fully understand its contents.

Participant Name(Required)

Parent/Guardian Name(Required)

Parent/Guardian Signature(Required)

Date(Required)

Summer Camp Registration Form

Love Creek Farm Summer Riding CampHorseback Riding Questionnaire

Photo Consent and Release

Love Creek Farm Summer Riding Camp

Liability Release and Agreement for this Facility and Program

CAMPER MEDICAL EMERGENCY INFORMATION

In the event of an emergency, contact:

CONSENT PLAN

NON-CONSENT PLAN

LOVE CREEK FARM RELEASE AND HOLD HARMLESS AGREEMENT

Love Creek Farm Summer Riding Camp
Horseback Riding Questionnaire