WM. R. HEBERLE STABLES, INC.
751 BROWNCROFT BLVD.
ROCHESTER, NY 14625 - 482-1290 / 654-9027
RELEASE OF LIABILITY
The undersigned acknowledges that the handling and riding of horses is hazardous to both rider and horse and therefore willingly and knowingly accepts whatever risks are involved while riding on the premises of William R. Heberle Stables, Inc. The understanding hereby releases instructors at William R. Heberle Stables, Inc. and/or William R. Heberle and/or William R. Heberle Stables, Inc. from all liabilities arising out of any occurrence which result in injury, loss and/or damage to the student, horse and/or equipment. Additionally, the undersigned prohibits any relative, representative and/or agent from seeking relief for damages from instructors at William R. Heberle Stables, Inc. and/or other instructors and/or William R. Heberle and/or William R. Heberle Stables, Inc. on behalf of the undersigned.
Print parent or guardian name : ______________________________
Date : ______________
Signed, parent or guardian for student under age 18:_______________________________Date: _______________
Student's Doctors Name : _______________________________Phone number: _______________
NAME:________________________________________________________
ADDRESS:_____________________________________________________
_____________________________________________________
PHONE NUMBERS:____________________________________
EMAIL ADDRESS:______________________________________________
CAMP WEEK_________________________ FULL / HALF DAY___________
PAYMENT AMOUNT:______________________ CHECK #:__________
NO REFUNDS
DATE OF BIRTH OF CHILD__________________________
ADDITIONAL INFORMATION; allergies, intolerance's to food
Day:__________
Time:_________
Heberle Stables
http://www.heberlestables.com/staticpages/index.php/camp_release