RESTLESS PINES RIDING SCHOOL NEW STUDENT APPLICATION
Restless Pines Farm
1418 Lucasville Road
Hammonds Plains, NS B4B 1P7
[email protected]
902-209-7355
www.restlesspines.com
Lesson Policies:
• Payment is due the first of the month. After that late fees are incurred at
$25 per week. We only accept e-transfer ([email protected] –
password: restlesspines. Please note the name of student and date of the
lesson in the e-transfer
• All students must sign a waiver.
• We have a no make-up policy as our program is full and does not allow for
adding extra lessons. The exception being makeups provided should we
cancel lessons for horse shows, or if we cancel for storms. Any cancellations
will be communicated by email.
• Notice to stop riding at RPF: If you decide you no longer wish to ride at
Restless Pines, 30 days’ notice must be given and responsibility to pay for
the 30 days is mandatory.
Rules & Policies:
• No smoking on property (no exceptions!)
• All dogs must be on leash
• No one other than RPF students who have signed a waiver are permitted to
handle or ride horses It is the student’s responsibility to provide his/her
own riding and safety attire: ie: approved helmet, boots with a heel, pants
that fit properly and won’t chafe, gloves as needed.
• Students should arrive a minimum of 30 minutes prior to their lesson to
groom and tack up. Please be early so we don’t hold up the lesson for late
comers – it is at instructor’s discretion to allow access into lesson based on
time. No makeup for late or part missed lessons.
• Students should plan to stay minimum of 30 minutes after lesson to allow
for horse care and light chores (ie. Hay, water, sweeping, raking, picking
stall)
• All doors are to be kept closed as horses are brought in/taken out for
lessons. If your horse makes manure in entrances or isles please clean up
immediately.
• After the lesson, it is the student’s responsibility to put all tack and brushes
away, clean up after their horse, sweep and make sure horse has sufficient
hay and water in stall or paddock
• Students should pick up any manure left by their horse in the ring and
walkways after their ride. Wheelbarrows and forks are provided around the
barn and arena. Horses hooves must be picked out before leaving arena
each ride.
• When riding with others, always pass left to left. If cooling your horse out
after a ride, please stay to the inside track
• Student attire required: certified helmet - tipperary or better, riding pants,
paddock boots, half chaps, gloves, grooming kit, lead line
STUDENT INFORMATION
Name: _________________________________D.O.B. if under 21: ___________
NSEF #: __________________________
Name of both Parent(s)/Guardian(s) if under 21: __________________________
Emergency Contact and Phone Number:_________________________________
Contact Info of Parent/Guardian: ______________________________________
Home Phone: _________________ Cell: __________________
Email Address: ______________________________________________________
Address:____________________________________________________________
Health Card #: __________________________________________ Exp: ________
Riding Experience/ Rider Level:
___________________________________________________________________
___________________________________________________________________
Riding Goals:
___________________________________________________________________
___________________________________________________________________
Show Experience/ Height Showing:
___________________________________________________________________
___________________________________________________________________
Other Comments: Show Experience:
___________________________________________________________________
___________________________________________________________________
RESTLESS PINES FARM
EQUESTRIAN ACTIVITIES
WAIVER AND RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in the RESTLESS PINES FARM
equestrian program, related events and activities, the undersigned acknowledges, appreciates,
and agrees that:
RIDERS NAME:__________________________________________________
1. The risk of injury from the activities involved in this program is significant, including the
potential for permanent paralysis and death, and while particular rules, equipment, and
personal discipline may reduce this risk, the risk of serious injury does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF
ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility
for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for
participation. If however I observe any unusual significant hazard during my presence or
participation, I will remove myself from participation and bring such to the attention of the
nearest official immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin,
HEREBY RELEASE AND HOLD HARMLESS: RESTLESS PINES FARM, their officers, officials, agents
and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if
applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH
RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property,
WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY
SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
X __________________________________________
PARTICIPANT’S SIGNATURE
X __________________________________________ Date Signed: _______________________
WITNESS
WITNESS FOR PARTICIPANTS OF MINORITY AGE
(UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this
participant, do consent and agree to his/her release as provided above of all the
Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree
to indemnify the Releasees from any and all liabilities incident to my minor child’s
involvement or participation in these programs as provided above.
X _________________________________________
PARENT/GUARDIAN’S SIGNATURE
__________________________________________
EMERGENCY PHONE NUMBER
X ________________________________________
WITNESS
