Submit this form by cut and pasting into the body of an email or scan and attach to an email and send to TheSpotliteFoundation@gmail.com. We do not accept checks. Please send payment to firstname.lastname@example.org through paypal and if you do not have paypal, we will send you an invoice payable online.
QUESTIONS WITH THIS FORM? CALL (360) 360-780-0808
Please note that your camp spot is not secure until we receive a deposit.
YOU ONLY NEED TO SUBMIT THIS ENTIRE FORM 1X EACH YEAR. IF WE HAVE IT ON FILE FOR YOU ALREADY, ONLY FILL OUT THE FIRST PAGE, INDICATING YOUR CAMP PREFERENCE AND CONTACT INFO, INCLUDING EMAIL.
I WOULD LIKE TO TAKE THE WRANGLER TEST AT CAMP: Y N
At this time I classify myself as a (please circle): Wrangler Jr. Wrangler Complete Beginner
Email Address: __________________________Print carefully. We create a database of emails for all campers in a specific session. It is our main form of communication.
Health Card Number or Medical Insurance:_______________________
Citizens other than American may be required to provide a credit card in the event medical attention is needed.
Does your camper want to ride English (Jumping, Hunt Seat, Dressage) or Western seat? ___________________
This is only to help us determine general interest in each discipline. Every camper has the option of choosing a different discipline once at camp.
What are your riding goals? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What are you looking forward to doing at camp other than riding? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Does the camper have any emotional, behavioral, physical, allergies or other challenges of which we should be aware? :_______________________________________________________________________________________________________________________________________________________________
Please let us know of any dietary restrictions______________________________________________________________________________
Release executed on the ____ day of _______, 20___by _____________________( the ‘Releasor’) and minor child_______________________ of (Address) _________________________, (City)_______________(State)_____
(County)____________, to Chastain Mist and Company, and all agents .
Conditions of Registration: I, the parent/guardian of the above-named participant, release Chastain Mist Summer Camp, Chastain Mist and Co., Chastain Mist Equestrian, LLC, its director, staff and agents from any loss, personal injury, accident, misfortune or damage to the above- named camper or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the above-named camper. The camp director reserves the right to dismiss a camper who, in the opinion of the director, is a hazard to the safety and rights of others or who appears to have rejected the reasonable controls of camp. No refund will be made for dismissals due to disciplinary action. Each camper must be covered by medical insurance. The parent/guardian certifies that the camper is in good health, normal in condition and habits, and is amenable to camp life. By signing this form the parent/guardian is giving the camp staff the right to obtain medical attention necessary for the campers welfare and good health. The parent/guardian is responsible for all costs incurred. I hereby give permission for my son/daughter to participate in the entire program, and permission for Chastain Mist to act in my behalf in case of sickness or emergency. I give permission to Chastain Mist to use any photograph or video of my child for promotional material and that my positive statements about Chastain Mist may be used as testimonials in materials publicizing the camp program.
I, The Releasor, in consideration of my minor son or daughter or self being permitted to participate in any Chastain Mist and Company program, including but not limited to riding Lessons, riding camp, horse boarding, field trips, trail rides, run and/or operated by the Releasee, WAIVE, RELEASE, and DISCHARGE the Releasee, his/her heirs, executors, administrators, legal representatives and assigns from all liability for or by reason of any damage, loss, or injury to person and property, even injury resulting in death of myself or above named minor child, which has been or may be sustained in consequence of the Releasor’s participation or the participation of the Releasor’s child in the activity described about, and notwithstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Releasee.
I hereby acknowledge and agree that I have carefully read this Waiver and Release agreement, that I full understand same, and that I am freely and voluntarily executing same.
By signing this release I will be forever prevented from suing or otherwise claiming against the Releasee for any property loss or personal injury that I may sustain while participating in or preparing for the above noted activity.
I have been given the opportunity and have been encouraged to seek independent legal advice prior to signing this Waiver and Release agreement.
I understand that this Waiver and Release agreement is binding on me, my spouse, my heirs, my executors, administrators, personal representatives and assigns.
I acknowledge that I do not have nor does my minor child have any physical limitations, medical ailments, physical or mental disabilities that would limit or prevent me from participating in the above mentioned activity.
This release contains the entire agreement between the parties to this release and the terms of this release are contractual and not a mere recital.
I acknowledge that all guarantees of horseback riding time are dependent on multiple variables that are out of the control of camp owners, employees, staff, volunteers, and associates. Ride time may be shortened due to inclement weather, horse illness, camper injury/illness, premature camper departure, and ride time may also be deducted as a discipline measure. I understand that Chastain Mist will do everything in its power to provide maximum ride time, but I agree to hold harmless all above mentioned parties in the event that the full amount of ride time isn't completed.
In addition, I realize that many activities offered require a certain amount of study and physical ability by my camper and I give permission to Chastain Mist to assess the ability of my child and decide whether or not he/she may participate. This includes but is not limited to Polo, Jumping, Cantering, and Trotting.
This Waiver and Release Agreement will be construed in accordance with and governed by the laws of the State of WASHINGTON, and it is acknowledged by the Releasor to be as broad and inclusive as permitted by the laws of this jurisdiction.
Check this box if your child can participate in all activities, including off site field trips with Chastain Mist. If box is not checked, child does not have permission to participate.
I HAVE READ AND UNDERSTAND THIS AGREEMENT, AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEE(S).
I have read and understand the contents of this application, including the Cancelation Policy, Payment Policy and Conditions of Registration. This application has my approval and consent:
The Releasor has executed this Waiver and Release at (City)______________,_______________(County),
WA on the _____day of __________, 20___.
Signature of Releasor ___________________________________
Signature of Camper _____________________________________