Stillwater Stables Summer Camp 2024
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Which camp(s) are you signing up for?
Participant Name and Age *
OHIP#
Full Address (Including Postal Code) *
Does the participant have any allergies? If so, please, list all allergies and medications. *
Is there anything else we should know about the participant?
Primary Contact Name *
Primary Contact Relationship to Participant *
Primary Contact Email *
Primary Contact Phone Number *
Primary Contact Alternate Phone Number
Secondary Contact Name *
Secondary Contact Relationship to Participant *
Secondary Contact Phone Number *
Third Contact Name *
Third Contact Relationship to Participant *
Third Contact Phone Number *
In consideration of being allowed to participate in any way at Stillwater Stables, 5219 Russell Road, Ottawa, Ontario K0A 1K0, the undersigned acknowledges, appreciates, and agrees that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Stillwater Stables, Bethany Groleau, Joey Groleau, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEESOR OTHERWISE. Photo/Video: I hereby release and acknowledge that Stillwater Stables may use photos and videos of the participant for teaching and promotional materials. I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above. I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above. Please write the Participant (over 18) or Parent/Guardian Signature below with the date. *
Photo/Video: I hereby release and acknowledge that Stillwater Stables may use photos and videos of the participant for teaching and promotional materials. Please initial. *
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above. Please initial. *
To complete the registration, please, transfer $100 deposit to info@stillwaterstables.ca with the password Stillwater
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