Use this form after payment has been submitted through PayPal or if you wish to register your student and mail in payment. If you have not paid online and wish to do so, CLICK HERE. Then complete the form below to register your student for specific dates & programs.

   
All fields are mandatory for first time students!
Students Name First Last
Birthdate
Parent or Guardian
Street
City , State Zip :
Home Phone    Work Phone :
Emergency Contact   Emergency #:
Session Date
Hold CTRL Key To Select Multiple Options

Drop off Time
 Pick Up Time :
Person Picking Up or Authorized Person
Has child ridden before
  Taken Lessons :   # of Years :
Cantered?
Jumped? Former Camp Student:
If currently a riding program student, where and for how long
(specify where and for how long)
Payment Information
How did you hear about us

In consideration of being permitted to use horses and equipment owned by or in the care, custody and control of Gallop On Farm ("the Farm"), the undersigned ("Licensee"), and his or her family, estate, heirs or assigns, hereby agree to release and hold harmless the Farm, its agents and assistants from and against any claim, action, damage, expense, loss, or liability paid, suffered, or incurred, whether foreseen or unforeseen, as a result of the use by Licensee of such equipment and horses. Licensee hereby assumes liability and responsibility for loss by theft, accident or damage from any cause occurring to such equipment and horses, and agrees to return such equipment and horses in the same condition as when received.

Licensee acknowledges that he or she has been advised that horses and ponies are sometimes unpredictable and that there is a risk involved in riding, and with such knowledge Licensee hereby agrees to assume such risk. Gallop On Farm does not carry medical insurance for its students and customers. Camp attendees must attain desired coverage.

NOTICE: The helmets provided by the Farm are made available for your convenience only. Gallop On Farm makes no representations or warranties regarding the extent these helmets will protect you against injury as a result of impact, accident or fall.

The Farm strongly recommends that you obtain your own properly fitted protective headgear meeting current safety standards, and that you wear it whenever you ride.
Gallop On Farm reserves the right to refuse or terminate camp enrollment of any child who, in Gallop On Farm's sole discretion, presents a danger to him or herself, other campers, staff, the horses, or the facility.

I (WE) HAVE READ THE ABOVE RELEASE AND DISCLAIMER OF LIABILITY AND UNDERSTAND ITS PROVISIONS.


(clicking submit will take you to completed form you can fill out, sign and mail in with check or money order.