Hever Farm - Confidence Clinic


Confidence Building Clinic Registration Form
Today's Date:
First Name:
Last Name:
Horse's Name:
Address Line 1:
Address Line 2:
City:
State:
Zipcode:
Home Phone:
Cell Phone:
Email:
Choose a Clinic Date/s:		July 22
		August 11
		September 16
		October 20
- Release Form - I realize that there is inherent danger in participating in any horse-related activity. In consideration for services or property provided, I, for myself, guests and any minor chilren for which I am parent, guardian or otherwise responsible, any heirs, personal representatives or assigns do hereby release Hever Farm, LLC, The Sarosi Family and any volunteers and helpers from all liability and waive any claim for damage from any cause whatsoever. This agreement is made pursuant to the provisions of the Virginia Equine Activity Liability Act (Title 3.1, Chapter 27.5 & 3.1-796, 138 ET seq.)
By filling out this form and Checking off the Yes Box, I agree that I have Read and Understood the foregoing release and that I am 18 years of age or older. Yes
If you are a Parent or Guardian signing the foregoing release, enter your name here:
Email us your Completed Registration Form and send your non-refundable payment to: Hever Farm, LLC 4825 Old Fredericksburg Road Mineral, VA 23117: