2016 Fairhaven Farm
*Road to Rio* Olympic Summer Adventure
Rider Name:_______________________________________________Rider Age:__________
Chosen Dates to ride:__________________________________________________________
(50% non refundable deposit required to hold spot. Balance 2 weeks prior to your start date. Amount enclosed:___________ Allergies:___________________
Circle riders Experience: If in doubt chose the lower of two categories.
Fairhaven Farm Release – 2016
WARNING! Under Georgia Law, an equine activity sponsor or equine professional is not liable for an injury to or death of a participant in equine activities resulting from the inherent risk of equine activities, pursuant to Chapter 12 of Title 14 of the Official Code of Georgia Annotated.
I have read and fully understand the above stated Georgia Equine Activity Liability Act, and will not hold Fairhaven Farm, Inc., its owners, or anyone associated responsible for ANY accident, injury or death to rider, horse, participant, family member, groom, spectator or anyone associated with horse or rider. Fairhaven Farm, Inc., its owners or anyone associated is not responsible for ANY medical bills that could possibly incur to horse, rider or anyone associated with the horse or rider.
Signed by rider/owner of horse (parent or guardian must sign if rider
is under the age of 18)
Parent 1 Signature: _____________________________________ Date: __________________
Parent 2 Signature:______________________________________ Date:___________________
Mail to: P.O. Box 131 Coosa Ga 30129 or scan and email to email@example.com