Clinic Application

For details and information regarding our Monty Roberts’ Join-Up® Clinics, please read thoroughly the enclosed information. If you have further questions, please call the number above.

APPLICATION - Please Print and Fill out the Form below.

First Name: ___________________________  

Last Name: ___________________________

Address: ______________________________________________

City: _____________________   State: ________

Zip: ___________

Phone/cell/fax: __________________________________________________

E-Mail: _________________________________________

Minimum age of participants is 13 years old. If under 16 years of age, participant must be accompanied by a fully enrolled adult. All applicants must sign attached release. Enrollment is limited to 4 people each clinic.

Horse Application

Horses must be at least two (2) years of age. If you wish to bring a horse to clinic, please provide the following information:

Arrival Date: ____________  

Name of Horse: ______________________

Stabling Requirements: _________________________________________

Age: _____ Sex: ______ Breed: ____________

Date of Flu/Rhino Inoculation: __________

  Please bring with you the following:

1. Current Coggins

2. Current Health Certificate

3. If coming from Arizona, New Mexico, or Texas, please have a negative vesicular stomatitis statement from your vet.

 Horses must also have sound feet in good condition, have both good vision and hearing, current inoculations, and be halter broken.

* Please attach a letter regarding any extra care, handling, training, or special problems you and your horse may have *

PAYMENT
To reserve your space, please print out this form and send a check for ¼ of the total cost of the clinic. The remaining ¾ will be payable the day you arrive. For example: the total cost of the 4-day-clinic with a horse is $650, send $162.50.

Upon receipt of payment, space for the requested clinic dates will be reserved pending availability. Please enclose a check (US funds only) for your enrollment fee. 

Make checks payable to WildeWood Farm, Inc. Please write the date of the clinic(s) you are attending on the check.

RELEASE AND INDEMNIFICATION AGREEMENT

All Participants must sign the following:

The undersigned Participant acknowledges that equine related activities are inherently dangerous and that any interaction with horses may result in bodily injury, property damage or even death.

Participant agrees to the following:

1. Participant hereby agrees to release, indemnify, defend and hold harmless WildeWood Farm, Inc., and it’s owners, agents, employees, and stockholders (collectively hereinafter referred to as "Farm"), from any loss, liability, claim, damage or expense arising out of, based upon, or as a result, direct or indirect, of Participant’s presence on Farm.
   

2. At all times while Participant is riding horses or handling horses on the Farm, Participant shall wear an approved riding helmet.
   

3. If Participant brings an action or arbitration against the Farm, or its owners, agents, employees or stockholders, with respect to Participant’s presence on the Farm, then the prevailing party in whose favor judgment is entered in such action shall be entitled to have and recover of the other party all costs and expenses incurred or sustained by such party in connection with the initiation and prosecution of the action including, without limitation, attorneys’ fees, expert witness fees, accountants’ fees and court costs, even though not taxable as such. As used herein, attorneys’ fees shall be actually performed in connection with the matters involved calculated on the basis of the usual fee charged by the attorneys performing such services and shall not be limited to "reasonable attorneys’ fees" as defined in any statute or court rule.
   

4. This agreement shall be binding upon Participant, his/her heirs, legal representatives, successors and assigns and shall inure to the benefit of Farm, their successors, legal representatives and assigns.
   

5. This agreement is subject to the laws of the State of Georgia and venue and jurisdiction for any action hereunder shall be in a court or competent jurisdiction located in Forsyth, Georgia. Under GA law, an equine activity sponsor or equine professional is not liable for an injury or the death of a participant in equine activities resulting from the inherent risk of equine activities, pursuant to Chapter 12 of title 4 of the official code of GA annotated.

By signing hereunder, Participant acknowledges the release and indemnification agreement stated above.

Print Name: ________________________________

Signature: _________________________________

Date: ____________

MINORS MUST HAVE THE FOLLOWING LIABILITY STATEMENT SIGNED BY THEIR PARENT OR LEGAL GUARDIAN (S):

We, the undersigned parents of ____________________, for and in consideration of our child’s participation at WildeWood Farm, Inc., state that we have read the waiver release to hold harmless written above and we expressly agree that the terms and conditions of said waiver and hold harmless shall apply to and be binding upon use and our minor child insofar as it pertains to his or her participation. We further warrant we have health and accident insurance on said minor, I declare under penalty of perjury that the foregoing is true and correct.

Print Name: ____________________________

Guardian Signature: ________________________ Date: ___________