MIKE AND BRENDA MCKINLEY, DBA. MCKINLEY’S HARMONY ACRES
PREMISES OWNERS NAME, hereinafter know as “THIS STABLE”
64247 LIBRARY ROAD, CASSOPOLIS, MI 49031
LOCATION OR ADDRESS OF STABLE
READ CAREFULLY AND COMPLETE ALL SECTIONS BEFORE SIGNING
MICHIGAN WARNING
Under the Michigan equine activity liability act, and equine professional is not liable for
an injury to or the death of a participant in an equine activity resulting from an inherent
risk of the equine activity.
Responsible Party's Agreement
I understand all Day Camp fees must be paid in advance. The Day Camp hours will be from 10:00
a.m. to 3:00 p.m., Monday through Friday. The non-refundable fee is $150.00 per child. You must
sign a liability waiver for your child and fill out the medical information sheet before your child
attends Day Camp. THIS STABLE is not liable for accidents. We do not provide health insurance
for your child. You are responsible for insurance, if you so desire. Additionally, this document gives
THE STABLE permission to treat/have the child treated in case of accident.
ALL MINORS (UNDER 18) ARE REQUIRED TO WEAR A HELMET WHEN RIDING
Clothing: Child must wear a tee shirt, long pants or jeans, and a close-toed shoe such as tennis
shoes. Please no tank tops, shorts or sandals. Long hair should be pulled back with a pony tail
holder. Child will also bring a helmet (bicycle or other helmets are acceptable).
Food: Child must bring a sack lunch. We will provide snacks and beverage.
SIGNER STATEMENT OF AWARENESS
I/WE THE UNDERSIGNED REPRESENT THAT I/WE HAVE READ AND DO UNDERSTAND THE
FOREGOING AGREEMENT, LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT.
I/WE ATTEST THAT ALL FACTS ARE TRUE AND ACCURATE. I AM SIGNING THIS WHILE OF
SOUND MIND AND NOT SUFFERING FROM SHOCK, OR UNDER THE INFLUENCE OF
ALCOHOL OR INTOXICANTS.
X_____________________________________________________________________________
Responsible Party’s Signature Date
______________________________________________________________________________
Address Phone
______________________________________________________________________________
City State Zip Phone
______________________________________________________________________________
In Case of Emergency Contact Name Phone
The following child is permitted to participate in the Day Camp and therefore is included
under this agreement:
______________________________________________________________________________
(1) Child's Name Age
______________________________________________________________________________
Address
______________________________________________________________________________
City State Zip Phone
______________________________________________________________________________
(2) Doctor Contact Information
______________________________________________________________________________
Doctor Phone
______________________________________________________________________________
Hospital
(3) Medications (please list any medications the child is on)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(4) Allergies/ Related Health Issues (please list)
_____________________________________________________________________________
______________________________________________________________________________
PREMISES OWNERS NAME, hereinafter know as “THIS STABLE”
64247 LIBRARY ROAD, CASSOPOLIS, MI 49031
LOCATION OR ADDRESS OF STABLE
READ CAREFULLY AND COMPLETE ALL SECTIONS BEFORE SIGNING
MICHIGAN WARNING
Under the Michigan equine activity liability act, and equine professional is not liable for
an injury to or the death of a participant in an equine activity resulting from an inherent
risk of the equine activity.
Responsible Party's Agreement
I understand all Day Camp fees must be paid in advance. The Day Camp hours will be from 10:00
a.m. to 3:00 p.m., Monday through Friday. The non-refundable fee is $150.00 per child. You must
sign a liability waiver for your child and fill out the medical information sheet before your child
attends Day Camp. THIS STABLE is not liable for accidents. We do not provide health insurance
for your child. You are responsible for insurance, if you so desire. Additionally, this document gives
THE STABLE permission to treat/have the child treated in case of accident.
ALL MINORS (UNDER 18) ARE REQUIRED TO WEAR A HELMET WHEN RIDING
Clothing: Child must wear a tee shirt, long pants or jeans, and a close-toed shoe such as tennis
shoes. Please no tank tops, shorts or sandals. Long hair should be pulled back with a pony tail
holder. Child will also bring a helmet (bicycle or other helmets are acceptable).
Food: Child must bring a sack lunch. We will provide snacks and beverage.
SIGNER STATEMENT OF AWARENESS
I/WE THE UNDERSIGNED REPRESENT THAT I/WE HAVE READ AND DO UNDERSTAND THE
FOREGOING AGREEMENT, LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT.
I/WE ATTEST THAT ALL FACTS ARE TRUE AND ACCURATE. I AM SIGNING THIS WHILE OF
SOUND MIND AND NOT SUFFERING FROM SHOCK, OR UNDER THE INFLUENCE OF
ALCOHOL OR INTOXICANTS.
X_____________________________________________________________________________
Responsible Party’s Signature Date
______________________________________________________________________________
Address Phone
______________________________________________________________________________
City State Zip Phone
______________________________________________________________________________
In Case of Emergency Contact Name Phone
The following child is permitted to participate in the Day Camp and therefore is included
under this agreement:
______________________________________________________________________________
(1) Child's Name Age
______________________________________________________________________________
Address
______________________________________________________________________________
City State Zip Phone
______________________________________________________________________________
(2) Doctor Contact Information
______________________________________________________________________________
Doctor Phone
______________________________________________________________________________
Hospital
(3) Medications (please list any medications the child is on)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(4) Allergies/ Related Health Issues (please list)
_____________________________________________________________________________
______________________________________________________________________________
| DAY CAMP AGREEMENT |
