Summer Horse
Camp Registration Form
Please print this form and fill out completely, then return form with your payment to:
Mikenda Farm,
4740 Lazy H Lane,
Christmas, FL 32709 ***
(407) 568-8418***We are holding Summer Camp during the following day(s).
June 9-13, June 16-20, and June 23-27th
Please check which dates you would like to indicate which days you are registering for.....
□ June
14-18 □
June 21-25 □
June 28-July 2 □
July 12-16
Cost is $240 per week. Hours from 8:30am - 2pm
Please send in one-half deposit to Mikenda
Farm prior to camp. All
deposits received are non-refundable. Balance of registration fee due the first day of camp.
PARENT'S NAME____________________________________
E-MAIL _______________________
ADDRESS _____________________________________CITY_______________________ ZIP ______________
DAY PHONE #_________________EVENING PHONE # _________________
EMERGENCY # _________________
CHILDREN INTERESTED IN ATTENDING THE CAMP:
|
Name of Child
____________________________
|
Age
_____ |
Experience Around Horses
_____________________________
|
|
Name of Child
____________________________
|
Age
_____ |
Experience Around Horses
_____________________________
|
|
LISTED BELOW ARE ANY HEALTH PROBLEMS OR CONDITIONS
THAT SHOULD BE NOTED:
______________________________________________________________
|
(Children are given a half-hour early/late window). Parents who will have difficulty dropping off or picking
up their child at those times can request extended hours for an additional hourly charge.
Please indicate here: ________________________________________.
FOR AND IN CONSIDERATION OF THE ABOVE SERVICES, Equine
Participant does forever and finally release, remise, acquit, satisfy and
forever discharge Brenda Hagemeister, DBA Mikenda Farm, and
those individuals listed as Mikenda Farm Instructors of and from all manner of action and actions,
cause and causes of action, suit, debts, dues, sums of money, bonds, billings, contracts, controversies,
agreements, promises, damages, variances, judgments, executions, claims and demands whatsoever, in law or
in equity, which may arise or might in the future arise or hereinafter may arise for or against
Brenda Hagemeister, DBA Mikenda Farm, and those individuals listed as Mikenda Farm Instructors for the services
stated above.
This document is meant to be a full and complete release from any and all liability that may arise from
instructing the Participant on how to properly ride, manage and care for horses. This release is given
freely and voluntarily by the Participant and is meant to remain in existence throughout the duration of any
instruction.
WARNING: Under Florida law, an equine activity sponsor or equine activity professional is
not liable for an injury to, or the death of, a participant in equine activities resulting from the
inherent risks of equine activities.
_______________________________________________________________
PARENT'S SIGNATURE/DATE
Please print this form and fill out completely, then return form with your payment to:
MIKENDA FARM
4740 Lazy H Lane
Christmas, FL 32709
(407) 568-8418