| STUDENT REGISTRATION FORM Name (print) ________________________________________Age______ Parent or Guardian Name (print) _____________________________________________________ Relationship to student_____________________________________________ Address_________________________________________________________ City of Town______________________________________________________ Phone_____________________________ Email ________________________ Emergency Contact Name ________________________________________Phone______________ Medical Information Dr._______________________________ Phone_________________________ Allergies_________________________ Special Needs: _________________ Hold Harmless Agreement The undersigned hereby agrees to indemnify and hold William and or Sabina Andricovich, its Agents and or its Employees and or Sabills Morgan Horse Farm LLC, harmless of any and all claims of, injuries, death or damage to my person, and or my personal and or real property at the property known as Sabill’s Morgan Horse Farm LLC., located at 750 Southford Road Southbury Connecticut 06488, for any and all activities that the named participant below has contracted with William and or Sabina Andricovich, its Agents and or its Employees and or Sabills Morgan Horse Farm LLC, to participate on no specific date and as indicated herein. That the participant or its Parent and or Guardian has read and understands the Connecticut Equine Activity Statute below, and in signing the HOLD HARMLESS AGREEMENT acknowledges that William and or Sabina Andricovich, its Agents and or its Employees and or Sabill’s Morgan Horse Farm LLC., have not made any claims or misrepresentations as to the soundness and or safety of the horse(s) and or equipment that have been provided to me for my use for any and all activities such as Horse Back Riding Lesson(s) and or the Trail Ride(s) that I have requested to participate in. That the undersigned named as participant and or is Parent and or Guardian Hereby releases and discharges William and or Sabina Andricovich, its Agents and or its Employees and or Sabills Morgan Horse Farm LLC, from and all claims of injuries, death or damage to my person and or my personal property as a result from any activities that the undersigned participates in at its own free will and with out and reservations whatsoever. Connecticut Equine Activity Statute GENERAL STATUTES OF CONNECTICUT TITLE 52.CIVIL ACTIONS CHAPTER 926. STATUTE OF LIMITATIONS Conn. Gen. Stat. s 52-577p (1994) S 52-577p. Assumption of risk by person engaged in recreational equestrian activates, when Each person engaged in recreational equestrian actives shall assume the risk and legal responsibility for any injury to his person or property arising out of the hazards inherent in equestrian sports, unless the injury was proximately caused by the negligence of the person providing the horse or horses to the individual engaged in recreational equestrian activities or the failure to guard or warn against a dangerous condition, us, structure or activity by the person providing the horse or horses or his agents or employees. I have read the above and understand I am participating in a Horseback Riding Lesson and or Trail Ride under my own free will and at my own Risk. Signature and Date_________________________________________ |
| WELCOME TO SABILLS MORGAN HORSE FARM LLC! 750 Southford Road, Southbury CT. (203) 264-3965 -New Student Registration- |
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