West Equestrian Camp Page 1
please make sure to mail both forms....mailing address located at the bottom of page 2.
__________________________________________ ________________________________________
Participant name Parent name
___________________________________________________________________________________
Address city state zip
___________________________________________________________________________________
Phone (work) (home) (cell) (pager) (other)
______________________ __________ ______________________________________________
Birth date month/day/year Age Email
Riders Experience____________________________________________________________________
None_____1-10hrs lessons_______10-50hrs lessons___________50hrs +lessons__________
Own horse_______ English________ Western_______ Jump_______ Dressage_________
No lessons but ride often_______ This info will help put riders of similar ability together.
In case of emergency contact ____________________________________________________________
Name Relationship Phone
Physician and Hospital _________________________________________________________________
Insurance Group Name_________________________________________NO#_____________________
Insured Name________________________________________________ Insured ID#_______________
$50 non refundable deposit required with enrollment.
Make checks payable to West Equestrian.
Remainder must be paid 7 days prior to camp.
Camp Regular_____Advanced_______5-7 Jr___________
Date :_________________
I need to try out for advanced camp. Yes_______ No_________
current student_________ (contact instructor for approval)
Medical Release:
I hereby give West Equestrian and its instructors and associates, permission to act as temporary guardian
of________________________________________ from ____________ to ____________(camp date). I
hereby authorize The above mentioned of 5716 Dip Creek Rd. Sand Springs to transport and/or authorize
proper licensed/certified medical personnel to treat injuries and/or illnesses as they deem necessary.
_____________________________ ________________
Signature Guardian/Parent Date
Page 2
Oklahoma Livestock Activities Liability Limitation Act Section 50.1 of Title 76 B. 1. The Oklahoma
Legislature recognizes that persons who engage in livestock activities may incur injuries as a result of the
risks involved in such activities even in the absence of any fault or negligence on the part of persons or
entities who sponsor, participate or organize those activities.
Horse back riding, care of, and exposure to horses, and the use of any horse or horseback riding
equipment involves risk and danger, and/or injury. The behavior of the horse can be unpredictable, and
at times based on instinct or fright, which may cause injury. Horses may bite, kick, buck, lie down, stumble,
or fall. Saddles may slip, tack may loosen, and wear tear may cause tack problems. All efforts will be
made to make sure equipment remains serviceable and safe, but unforeseeable events could occur.
Terrain ridden is subject to change, due to weather and natural causes. Terrain, and obstacle variations
could cause loss of control, and, or injury.
Signature of this form admits awareness that this activity entails risks of injury or death. I understand that
the description of these risks is incomplete, and that unknown or unanticipated risks may occur. I agree to
assume responsibility for all identified and unidentified risk factors. My participation in this activity is purely
voluntary, and I elect to participate, despite the previously mentioned risks. I further agree not to hold
West Equestrian Services and Training responsible for any accidents that may occur.
I certify that the I am, or my minors are, fully capable of participating in this activity, and assumes full
responsibility for myself, and minor children, for bodily injury, death, and loss of personal property, and all
expenses thereof, as a result of those inherent risks and dangers, and of any negligence in participating in
this activity. I have read this, agree with it, and have advised my child or ward to obey rules of West
Equestrian. I personally carry hospital insurance on my child or ward and accept this responsibility.
I have read, understood, and accepted the terms and conditions stated herein and acknowledge that this
agreement shall be effective and binding upon myself, my heirs, assigns, personal representative, estate,
and for all members of my family, including minors accompanying me, or participating in anything involved
with horses, events, or activities related to horses, and fund raising both on and off West Equestrian
Properties. This agreement will be effective until written notice by the participant of cancellation of
lessons.
_____________________________ ________________
Signature Guardian/Parent Date
Mail To:
West Equestrian C/O Summer Camp
5716 S. Dip Creek Rd
Sand Springs OK 74063
For Office Use Only
Camp cost ________
Deposit ________
May 15 discount ________
June 1 payoff disc. ________
__________other ________
Amount due _______
Amount paid _______
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