Registration for Summer Camp July / August 2019

Campers First Name

Campers Age at time of camp?

Mailing Address

Campers Last Name

City, State, Zip Code

Mobile Number

Email Address

Emergency Contact Name:

Emergency contact Phone:

I understand Summer Camp at Sterling Pointe Farm costs $80.00 per day / $400.00 per week Monday - Friday - 9 am - 2 pm / Payment is due at First Day Attended

I Agree

I would like to Sign up to Attend Summer Camp 2019

Full Week July 22-26, 2019

Full Week August 12-16, 2019

Single Day(s) July Week

Single Day(s) August Week

Please choose one from above. Required

WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT In consideration for the privilege of boarding, riding, training, taking riding instruction and / or engage in any equine activity around horses at Sterling Pointe Farm, LLC. I nearby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Goldman Industries, LLC, and or, Kenneth Goldman, Sandra Goldman and family and, their officers, agents, servants, or employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death that may be sustained by me or any of the property belonging to me including my horse, WHETHER CAUSES BY THE NEGLIGENCE OF THE RELEASEES or otherwise while participating in such activity, or while in, on or upon the premises where the activity is being conducted. I am fully aware of the unusual and substantial risks involved and hazards connected with ALL activities involving horses including but not limited to stabling, training, and riding of horses in arenas, round pens, on trails and in all areas while working with all horses, whether that horse is owned by me or by RELEASEES. I hereby elect to voluntarily participate in said activity with full knowledge that said activity may be hazardous to me, my horse and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH that may be sustained by me, or any loss or damage of property owned by me, as a result of being engaged in such activity. WHETHER CAUSED BY THE NEGLIGENCE, NEGLECT, OR FAULT OF RELEASEES OR OTHERWISE. I understand that the sport of horses is a high risk sport and that I am participating at my own risk and in FULL knowledge that there is an element of risk that an accident could occur and result in injury or death to the rider. I also understand that while participating in this high-risk sport, It is highly recommended and requested by RELEASEEs to wear an approved horse riding helmet with a fixed harness, riding boots and appropriate riding attire I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage or costs, including court costs and attorney fees, that may incur due to my participation in said activity, WHETHER CAUSED BY NEGLIGENCE, NEGLECT, OR FAULT OF RELEASEES or otherwise. This waiver of Liability and Hold Harmless-Agreement shall bind the members of my family and spouse, If I am-alive, and my heirs, assigns and personal representative, If I am deceases, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above-named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Massachusetts. IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed: no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Release for full adequate and complete consideration fully intending to be bound by same.

I agree & Consent, I am over the age of 18 years of age. If I am not the participant, I am the parent or guardian for a rider under the age of 18.

By typing my name I am signing & Consenting to the Sterling Pointe Farm Waiver.