Summer Children’s Integrated Horse Camp 2022 Registration Form
        Date of Camp Week Registering for: _____________________________________________
        Weeks Available: 
        Integrated Summer Horse Camp (Children 5 to 12 years old) July 4 to 8; July 11 
        to 15; July 18 to 22; Aug 8 to 12; Aug 15 to 19; Aug 22 to 26
        Time:  9:00am to 1:00pm
        Cost: $400.00/week 
        Note:  A non-refundable* payment of $200.00 is due upon registration to 
        secure a place for your child with the remainder due 30 days prior to camp 
        week. *Please note that in the event that we are forced to cancel camp as a 
        result of the COVID-19 pandemic, we will refund the deposit and/or full 
        payment.
        Payment can be made by: E-transfer to prancedeposit@bmts.com or by cheque to 
        PRANCE at Box 2037 Port Elgin, On N0H 2C0.
        Name of Rider/Camper: _________________________________________________________
        Address: ______________________  __________________________, _______________  __________________
                               Street                                 Town/city                Province     Postal code
        Email: _____________________________________________
        Date of Birth: __________________________ Sex:  ____ M   ____  F
                 (mm/dd/yy)
        Health card: _________________________________ Height: ______________ Weight: ____________
        Name of Parent of Legal Guardian: ___________________________________________________
        Phone #_________________________________  E-mail:________________________________________
                    Information regarding health care needs, allergies, special needs, fears or
                    anxieties, etc.:
                    _________________________________________________________________________________________________
                    _________________________________________________________________________________________________
                    _________________________________________________________________________________________________
                    _________________________________________________________________________________________________
                    _________________________________________________________________________________________________
                    Emergency Contact: _______________________________________________________________
                    Telephone#:  (H)__________________  Cell#:_____________________ (W)_______________________
                                             
                    In the event of an EMERGENCY where we are unable to reach you by phone and/or
                    you are unable to be present to make decisions regarding your rider/campers’
                    health needs, what clear instructions and steps do you expect PRANCE employees to
                    follow in your absence:
                    _________________________________________________________________________________________________
                                               Rider/Camper Information
                    Your previous experience:
                     ___ First-time rider          ___ Some experience           ___ Regular lessons
                    ___ Intermediate rider         ___ Advanced rider
                    You can do the following confidently:
                    ___ Walk                       ___ Trot                      ___ Canter
                    Are you currently in a lesson program?
                    ___ Yes   ___No
                    How long have you been riding horses or ponies? __________________(years)
                    Do you have any other previous injuries that might affect your riding? 
                    _____________________________________________________________________________________
                    Have you ever fallen off a horse? Is so what happened? 
                    ______________________________________________________________________________________
                     Did your fall result in a concussion?
                     _________________________________________________________________________________________________
                     If yes, what was your physician’s advice regarding horseback riding?
                     _________________________________________________________________________________________________
                     ______________________________________                            ______________________________
                     Parent/Guardian Signature                                                                            Date
          ACKNOWLEDGMENT OF RISK & RELEASE OF LIABILITY - 18 &
                           Under
         For Participants Under the Age of Majority in Ontario where Equine Activities are Provided by 
         the Host
           WARNING: THIS AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS. READ IT CAREFULLY!
         The Parent/Guardian Must Read and Understand this Waiver Prior to Infant Participating in 
         Equine Activities
         The following waiver of all claims, release from all liability, assumption of all risks, agreement not
         to sue and other terms of this agreement are entered into by me on behalf of the Infant 
         Participant named below with and for the benefit of Pegasus Riding Association Nurturing 
         Challenged Equestrians (PRANCE), its directors, officers, employees, volunteers, business 
         operators, agents, and site property owners or lessees (the “Host”). Without limiting the 
         generality of the foregoing, “Equine Activities” includes but is not limited to competitions, 
         tournaments organized and /or operated by the “Host”, riding instruction, coaching and training 
         provided by the "Host" to the Infant Participant.
         Please Initial Each Item below after Reading and Understanding each item:
         1.  I am the Parent/Guardian of the Infant Participant and am executing this waiver on behalf of 
         the Infant Participant in my capacity as Parent/Guardian and with the intent that this waiver be 
         binding on myself and the Infant Participant for all legal purposes. ________
         2.  I am aware that there are inherent dangers, hazards and risks (“Risks”) associated with 
         "Equine Activities" and injuries resulting from these "Risks" are a common occurrence. I am 
         aware that the "Risks" of "Equine Activities" mean those dangerous conditions which are an 
         integral part of "Equine Activities", including but not limited to:  ________
         (a) the propensity of any equine to behave in ways that may result in injury, harm or death to 
         persons on or around them and to potentially collide with, bite or kick other animals, people or 
         objects;
         (b) the unpredictability of an equine’s reaction to such things as sounds, sudden movement, 
         tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface 
         objects; and
         (c) the potential for other participants to behave in a negligent manner that may contribute to 
         injury to themselves or others, including failing to act within their abilities to maintain control 
         over an equine.
         (d) the potential of natural or man-made hazards being present that can cause me harm, 
         including communicable disease
         3.  I freely accept and fully assume all responsibility for all "Risks" and possibilities of any and all 
         personal injury, sickness, disease, medical payments, death, property damage or loss resulting 
         from the Infant Participant’s participation in "Equine Activities".  ________