horse Pony Kids Online RegistrationStep 1
This is an electronic registration form for the Pony Kids program. We need the following information for registration. Your E-mail is required by WSF only to correspond regarding registration, and camp.
* ALL marked fields are required.
Name of Child *
Age years*
D.O.B  /  / *
 
Childs Summer Address *
City *
State *
Zip *
 
Childs Mailing Address *
City *
State *
Zip *
 
Mothers Name *
Home phone number is required but list any number we can reach you at in the event of an emergency
home #  -  - *
summer house #  -  -
work #  -  -
cell #  -  -
 
Fathers Name *
Home phone number is required but list any number we can reach you at in the event of an emergency
home #  -  - *
summer house #  -  -
work #  -  -
cell #  -  -
 
E-Mail *
NOTE: This will be the primary method of correspondence for this registration

If rider is staying with someone other than a parent please indicate below:
NOTE: this person will be authorized to pick up your child.
Name of Person
Relationship
Phone  -  -
Residential Address
City
State
Zip

List any person(s) you authorize to pick up you child from the camp program at any time.
1.
Relationship
2.
Relationship
3.
Relationship

Medical Information:
Does the above named child have any medical or physical conditions of which Woodsong Farm should be aware of to participate in this program? *
If Yes explain
List any medications you child takes on a regular schedule:
List any allergies:
 
Local Doctor
Phone #  -  -
 
Local Dentist
Phone #  -  -
 
Insurance Company
Insurance ID #

Please list two (2) emergency contacts:
Person 1 *
Relationship *
Phone  -  - *
 
Person 2 *
Relationship *
Phone  -  - *

Child Medical Care and Liability Release

In the event of an emergency I give Woodsong Farm permission to obtain the services of the rescue squad and/or other medical care and/or dental care in my child's behalf at my expense.

I agree to have the CHILD appropriately attired for the riding program. I am advised that failure to meet this dress code may be a safety hazard, and will be at my/or my child's own risk.

WARNING: Under Massachusetts law, an equine 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, pursuant to section 2D of chapter 128 of the General Laws. I understand and agree that there is risk and potential danger of bodily injury and/or death in working with and/or riding horses/ponies. The size, strength, unpredictable nature, natural instincts, and behavior of horses/ponies allows for no guarantee of their reliability or safeness. Falls off the horse/pony, due to a rider's loss of balance or loss of control over the horse/pony, are common and should be anticipated as a part of riding at all levels of riding skill. Injury most commonly occurs in association with, but is not limited to, falls, being thrown from the horse/pony, dragged, bitten, kicked, stepped on, run away with, struck, pulled away from, or crushed by the horse/pony, falling with the horse/pony, and equipment failure or breakage.

I understand that Woodsong Farm regularly takes photographs and video tapes of our equine activity in which my child may appear. I give permission for the above to be used for books, photo albums, brochures, news letters, educational videos, press releases, student use and or advertising purposes.

Instructors or the directors reserve the right to withdraw any participant (a person taking part in any Woodsong Farm activity, or representing Woodsong Farm at an off premise activity) whose influence or actions are deemed harmful to themselves or others (including animals), or who will not follow the rules and policies of the program. If this occurs, no deduction or return of fee, or any part thereof, will be made. The use of illegal drugs, tobacco, alcohol, fighting, foul or abusive language, or animal abuse will not be tolerated and will be grounds for immediate withdrawal without any refunds.

My Electronic Selection attests to my understanding and acceptance of any hazards associated with horses or ponies for me and/or my CHILD and releases Woodsong Farm, its employees, and its heirs, and assigns from any and all liabilities arising from activities and events at or associated with Woodsong Farm. I further understand Woodsong Farm does not carry any insurance for me and/or my child or in my child's behalf.

Any legal action brought against Woodsong Farm, its assigns, heirs and/or employees will be dependent on proving gross negligence on the part of Woodsong Farm, its assigns, heirs and/or employees and will be limited to the total sum of five hundred dollars, or if less, the medical expenses involved in an injury sustained in connection with Woodsong Farm. If gross negligence is not proved, all legal fees and court costs incurred by Woodsong Farm, and the cost of Woodsong Farm collecting said fees, will be at my expense.

I understand that in the event of withdrawal, absence or dismissal of a child after June 1st that no portion of the tuition fee will be refunded, waived or exchanged. Payments less registration fee will be refundable until April 15th.

I authorize the calling of a physician, the transporting of my child and/or the providing of other necessary medical services including emergency transportation at my expense. A qualified staff person may administer first-aid to my child. The emergency contact persons may be contacted to take my child from Woodsong Farm.

If any part of this agreement is found to be invalid that part does not void the remainder of the agreement.



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