Junior Girl Scouts Horse Rider Badge Clinic at Briar Gate Farm The activities below will satisfy the requirements for the Horse Rider Badge. It is divided into two sessions; one ground-work and one mounted. Each participant will receive printed materials and a certificate of completion at the end. A minimum of 3 participants is required for each session; maximum is 6. Cost: $40 per participant (includes both sessions) 25% discount for groups of 4 or more Scholarships available Session I: 1 – 1 ½ hours; ground-work Get Ready to Ride: - Practice saddling and bridling a horse - Learn about each part of horse tack - Find out how to tie a safety knot and hitch a horse Equipment Expert: - Learn about various styles of saddles, bridles and bits - Help clean some of our tack - Receive a tack shop catalog Clips, Combs, and More: - Examine tools used to groom a horse and learn the purpose of each - Practice grooming a horse - Review safe stall and barn behavior Horse Anatomy: - Learn the principal parts of a horse - Find out how common horse ailments can be prevented Session II: 1 – 1 ½ hours; mounted In Good Form: - Learn to mount and dismount correctly - Practice turning and stopping a horse at the walk and trot Horses, Safety and You: - Learn safety regulations and equestrian etiquette - Practice an emergency dismount - Discover what to do if your horse rears, trips, bucks, stops or bolts Briar Gate Farm 11227 N. 66th St. Longmont, CO 80503 303-485-7885 www.briargatefarm.com Registration Form Junior Girl Scouts Horse Rider Badge Clinic Name: ____________________________________________ Parent’s Name: ______________________________ Age: _________________ Phone #:_______________________ Address: ___________________________________ Cell Phone #: ____________________ Date and Time Requested for Session I: __________________________________________ Date and Time Requested for Session II: _________________________________________ Emergency Contact During Clinic: _______________________________________ Food or other Allergies? ___ No ___ Yes ___________________________________ May we use photos of your child during the clinic for our website or in other promotional materials? ___ Yes ___ No Cost: $35 (includes both sessions) 25% discount for groups of 4 or more Mail payment to: Briar Gate Farm 11227 N. 66th St. Longmont, CO 80503 Make checks payable to Briar Gate Farm. ----------------------------------------------------------------------------------------------------------------Office Use Only Amount due: _________________ Payment Received: ________________ Check #: _____________ Briar Gate Farm Junior Girl Scout Horse Rider Badge Clinic Release of Liability Warning: Under Colorado Law, an equine professional is not liable for the injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to section 13-21-119, Colorado Revised Statutes. This RELEASE of LIABILITY is made and entered into on this _____ day of ________ , 20 ____, by and between _____Kate Johnson__________, hereinafter designated INSTRUCTOR and _____________________________________ hereinafter designated RIDER, and if RIDER is a minor, RIDER’s parent or guardian, __________________________. In return for the use, today and on all future dates of the property, facilities and services of the INSTRUCTOR, the RIDER, his/her heirs, assigns, and legal representatives, hereby expressly agree to the following: 1. RIDER agrees to assume ANY AND ALL RISKS INVOLVED IN OR ARISING FROM THE RIDER’S USE OF OR PRESENCE UPON INSTRUCTOR’S PROPERTY AND FACILITIES including, without limitation but not limited to, the risks of death, bodily injury, property damage, falls, kicks, bites, collisions with vehicles, horses or stationary objects, fire or explosion, the unavailability of emergency medical care, or the negligence or deliberate act of another person. 2. RIDER agrees to hold INSTRUCTOR and all of its successors, assigns, subsidiaries, affiliates, officers, directors, employees and agents completely harmless and not liable and release them from all liability whatsoever and AGREES NOT TO SUE them on account of or in connection with any claims, causes of action, injuries, damages, cost or expenses arising out of RIDER’s use of or presence upon INSTRUCTOR’s property and facilities, including without limitation, those based on death, bodily injury, property damage, including consequential damages, except if the damages are caused by the direct, willful and wanton negligence of the INSTRUCTOR. 3. RIDER agrees to waive the protection afforded by any statute or law in any jurisdiction whose purpose, substance and/or effect is to provide that a general release shall not extend to claims, material or otherwise, which the person giving the release does not know or suspect to exist at the time of executing the release. 4. RIDER agrees to indemnify and defend INSTRUCTOR against, and hold it harmless from, any and all claims, causes of action, damages, judgements, costs or expenses, including attorney’s fees, which in any way arise from the RIDER’s use of or presence upon the INSTRUCTOR’s property and facilities. 5. RIDER agrees to abide by all of INSTRUCTOR’s safety rules and regulations including but not limited to: * Riders must wear a securely-fastened helmet * Riders must wear long pants or jeans and boots or a shoe with a heel * Riders shall not enter a horse’s stall or paddock area without the instructor’s permission * Riders shall not mount any horse without instructor’s permission * Do not feed the horses unless approved by instructor * No running, jumping or yelling around the horses 5. This contract is non-assignable and non-transferable and is made and entered into the State of Colorado, and shall be enforced and interpreted under the laws of this state. Should any clause be in conflict with State Law, then that clause is null and void. When the INSTRUCTOR and RIDER and RIDER’s parent or guardian, if RIDER is a minor, sign this contract, it will then be binding on both parties, subject to the above terms and conditions. 6. In the event of a medical emergency and if the parent cannot be reached, INSTRUCTOR will seek appropriate medical attention including calling 911 or driving the child to a medical facility. ________________________________________ INSTRUCTOR’s Signature _________________________________________ RIDER’s Signature _________________________________________ RIDER’s Parent or Guardian (If RIDER is a minor.)