Camp Registration

Rider Registration and Release

  • Name of Rider:
  • Address:
  • City: , State: , Zip:
  • Date of birth: , Gender:  M F
  • Height: , Weight:
  • Home telephone: , Cell phone:
  • Email:

How much experience have you had with horses?
 Beginner Intermediate Advanced

What type of lessons are you interested in?
 Western Lessons English Lessons

Have you taken lessons or attended other camps before? If so, when and where?

How did you learn about our program?

A deposit of $100.00 is required to secure registration for all camps. What type of payment will you make for the deposit? (online payment is available for deposits only) - go to the bottom of the Camps page to make an online deposit

Emergency and Medical Information - (must be filled out completely by parent or guardian of applicant)

  • Parent/Guardian Name:
  • In case of emergency, please call:
  • Name:
  • Telephone: , Cell:
  • Name of Rider's doctor:
  • Address:
  • City: , State: , Zip:
  • Office telephone:

Any medical condition, physical or emotional we should be aware of?  No Yes
If Yes, please explain:

Is the rider taking any medications (prescribed or over the counter)?  No Yes
If Yes, please explain:

Who will be picking up the rider at the end of the day?

  • Name:
  • Phone:
  • Email:


I, the undersigned have read and understand, and freely and voluntarily enter into this release and hold harmless agreement with Alum Rock Riding Academy (ARRA) Deanna Marie Scanlan, understanding that this release and hold harmless agreement is a waiver of any and all liability(ies).

I understand the potential dangers that I could incur in mounting, riding, walking, boarding, feeding said horse; including, but not limited to, any interactions with other horses. Understanding those risks I hereby release that company, its officers, directors, hareholders, employees, and anyone else directly or indirectly connected with that company from any liability whatsoever in the event of injury or damage of any nature(or perhaps even death) to me or anyone else caused by of incidental to my electing to mount and ride a horse owned or operated by ARRA or Deanna Marie Scanlan.

I understand and recognize and warrant that this release and hold harmless agreement, is being voluntarily and intentionally signed and agreed to, and that in signing this release and hold harmless agreement I know and understand that this release and hold harmless agreement may further limit the liability of equine professionals to include any activity, whatsoever, involving an equine, including death, personal injury and or damage to property.

I recognize and agree that I know which equine professional(s) I will be working with, and acknowledge that I agree said equine professional(s) has/have made responsible and prudent efforts to determine my ability to engage in the equine activity, and has/have sufficient knowledge of my equine and horseback riding skills as to relieve, release and hold harmless said equine professional(s) from any continuing duty to monitor my equine activities.

I further voluntarily agree and warrant to release and hold harmless this(these) equine professional(s) from any liability whatsoever, including, but not limited to, any incident caused or related to said equine professional’s(s’) Negligence, relating to injuries known, unknown, or otherwise not herein disclosed; including, but no limited to, injury, death, or property damage from: mounting, riding, dismounting, walking, grooming, feeding; use of horse barn, paddock, trails, or horse ring, in any capacity; falling off horse whether horse is bucking, flipping, spooked; or my failure to understand any equine professional’s directions relating to my riding or otherwise use and control, or lack thereof, of my horse or the horse I have been assigned to.

Participants in the Alum Rock Riding Academy activities may be photographed and the images then used in Alum Rock Riding Academy promotional and educational materials. I allow Alum Rock riding academy to photograph my child for use in educational and promotional materials. I understand that these images can be used in Alum Rock Riding Academy’s materials without any payment of fees, in perpetuity.

Person voluntarily entering into this release and hold harmless agreement:

Date: , Printed name:

I accept the terms of the release:  Accept

The form submission confirmation will display below. If there are errors, please update and submit again. To clear the form use

Please see the Parent Information page for more details.

Comments are closed.