Fall/Winter/Spring Mini-Buckaroo Camp Registration

Note: This form is not a reservation for camp. In order to reserve your spot, you will need to complete your purchase after completing this registration.

Enrollment Guidelines - Please Read

• All campers must have the ability to follow and execute oral instructions.

• All camps are 5 days unless otherwise stated.

• Camps are non-refundable.

• A change fee of $15.00 will apply to any order changes.

• Kraus Farms reserves the right to change or cancel any camp due to low enrollment.

• Confirmation of the camp reservation will be sent via email. We strongly encourage early registration to ensure your first choice.

Camp date you selected to book:*

*Note: This form is not a reservation for camp. In order to reserve your spot, you will need to complete your purchase after completing this registration.

Number of Campers (required)

 
Do any of your campers have any medical issues, physical or mental conditions which may effect their ability to ride of which THIS STABLE should be aware?(This information MUST accompany this registration form.)
yesno

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Please contact the office at 636-225-9513 for information on requesting a waiver to get approval.
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Camper Contact Information

Camper 1 Info
Camper 1 Name (required)

Camper 1 Age (required)

Camper 1 Birthdate (required)

Camper 1 Riding Experience (required)
Less than 10 hours10 to 20 hours20 hours or more

Camper 1 Allergies, Medical Needs, Special Accommodations (required)
(This information MUST accompany this registration form.)

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Camper 2 Info
Camper 2 Name (required)

Camper 2 Age (required)

Camper 2 Birthdate (required)

Camper 2 Riding Experience (required)
Less than 10 hours10 to 20 hours20 hours or more

Camper 2 Allergies, Medical Needs, Special Accommodations (required)
(This information MUST accompany this registration form.)

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Camper 3 Info
Camper 3 Name (required)

Camper 3 Age (required)

Camper 3 Birthdate (required)

Camper 3 Riding Experience (required)
Less than 10 hours10 to 20 hours20 hours or more

Camper 3 Allergies, Medical Needs, Special Accommodations (required)
(This information MUST accompany this registration form.)

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Camper 4 Info
Camper 4 Name (required)

Camper 4 Age (required)

Camper 4 Birthdate (required)

Camper 4 Riding Experience (required)
Less than 10 hours10 to 20 hours20 hours or more

Camper 4 Allergies, Medical Needs, Special Accommodations (required)
(This information MUST accompany this registration form.)

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Emergency Contact Information

Contact 1 Name: (required)

Relationship: (required)

Day Phone: (required)

Contact 2 Name: (required)

Relationship: (required)

Day Phone: (required)

Insurance Information

Policy Holder Name:

Policy Holder Phone:

Insurance Carrier Name:

Insurance Policy ID#:

I, , agree to pay ANY medical costs and give permission for my child to be treated if I cannot be reached.
[acceptance* acceptance-1] Check this box to accept the above statement. (required) [/acceptance]

ACKNOWLEDGEMENT OF MISSOURI STATUTES

I also understand that by participating in the summer camp program and all that is involved, I release KRAUS FARMS INC. of any liability due to the following Missouri Statute:

WARNING: Under Missouri law, an equine activity sponsor, an equine professional, a livestock activity sponsor, a livestock owner, a livestock facility, a livestock auction market, or any employee thereof is not liable for an injury to or the death of a participant in equine or livestock activities resulting from the inherent risks of equine or livestock activities pursuant to the Revised Statutes of Missouri.

RIDING INSTRUCTION AGREEMENT AND LIABILITY RELEASE

By this agreement, made and entered this day of by and between , who resides at , hereinafter referred to as "I”, and KRAUS FARMS, INC. located at 333 Hillsboro Rd., High Ridge, MO 63049, hereinafter referred to as "THIS STABLE".

IT IS HEREBY AGREED TO AS FOLLOWS:

1. That I, the undersigned, do for myself or on behalf of my child or legal ward, hereby voluntarily request to participate in riding instruction as a student at THIS STABLE, and that student will either ride his or her own horse, or school horses provided by THIS STABLE for Instructional purpose.

2. That parent or guardian and student understand that horses are unpredictable by nature; that when frightened or angry or under stress, a horse's natural instincts are to jump forward or sideways, to run away from danger at a trot or gallop, to kick, to buck, to rear up in front, or to bite; that horses are extremely powerful; and that if a rider falls to the ground, the fall distance will be generally from 3.1/2 to 5.1/2 feet. I understand these risks, and I voluntarily assume these risks and dangers.

3. That parent or guardian and student understands that upon mounting the horse and taking up the reins the student is in primary control of the horse and that THIS STABLE is not responsible for the results of the student's actions or inactions. The student further agrees to not abuse, misuse or deliberately agitate the horse as these actions may result in increased risk to himself and others.

4. That I have been advised that students should purchase and wear a helmet or hard hat and to wear it in and around THE STABLE so as to prevent horse related injuries.

5. LIABILITY RELEASE: That I understand that, except in the event of THIS STABLE’s want on and willful negligence, I am responsible for bodily injury or property damage which I or my child or legal ward should sustain on THIS STABLE’s premises and/or trails and/or while riding a horse, and/or while in transit to or at horse show, trail rides, or similar expeditions, and for any time I or my child or legal ward shall lose from employment or school or other activity, and for medical expenses or any other expenses incurred because of such bodily injury or property damage. In consideration of being permitted to participate in all aspects of equine activity including but not limited to lessons, boarding, or riding, I understand that except for an intentional tort or gross negligence, I for myself or my legal ward, charge, person for who I am legally responsible, and personal property as well as personal representatives, my heirs, administrators and assigns, release, waive, discharge and covenant not to sue this stable and any of its officers, agents, servants, or employees, from all liability, all claims, all demands, all actions, and all causes of action, now or in the future, sustained by my person, or that of my child or ward, charge, person for whom I am legally responsible, and or property caused by the negligence of this stable. The undersigned hereby expressly agrees that this release and waiver is intended to be as broad and inclusive as permitted by the laws of the state of Missouri and that if any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I further state that I have carefully read the foregoing General Release, know the contents thereof and have signed the General Release as my own free act on behalf of myself and my personal representatives, heirs, administrators and assigns as well as my child or ward, charge, person for whom I am legally responsible, and or property.

6. That the student(s) is/are currently covered by accident medical insurance and will remain insured for the duration of all riding instruction at THIS STABLE. That I further understand that should medical emergency treatment be required, the current insurance information here listed will be provided to the attending clinic or hospital to cover future payment of Incurred bills.

7. That this agreement is entered into in the state of Missouri and will be interpreted and enforced under the laws of this state.

8. Upon the signing of this agreement, student acknowledges that he/she has read and agrees to be bound to THIS STABLE's rules attached as Exhibit "B" and Incorporated herein by this reference.

9. In order to be in the Kraus Farms Summer Camp and/or lesson program individual must possess the ability to follow and execute oral instructions.

I, THE UNDERSIGNED, BEING OF LEGAL AGE AND OF SOUND MIND AND NOT BEING UNDER THE INFLUENCE OF ALCOHOL, DRUGS, OR INTOXICANTS, HAVE READ AND UNDERSTAND THE FOREGOING AGREEMENT AND RELEASE. I ALSO ACKNOWLEDGE RECEIPT OF A COPY OF THIS AGREEMENT THIS DATE.

By signing below you:

• Consent to receiving electronic communications from us.

• Agree that electronic communications have the same effect as if provided to you on paper.

• Agree that your electronic signature (via filling in your name below) in connection with agreements and other communications has the same effect as an ink signature.

• Confirm that you are authorized to provide this consent on behalf of yourself and your minor.

Parent/Legal Guardian signature required for all assistants under the age of 18.
PARENT/GUARDIAN SIGNATURE:
DATE:
HOME PHONE:
OTHER PHONE:
CONTACT EMAIL:

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