| Student Registration Form |
STUDENT REGISTRATION FORM
Name (print) ________________________________________Age______
Parent or Guardian
Name (print) _____________________________________________________
Relationship to student_____________________________________________
Address_________________________________________________________
City of Town______________________________________________________
Phone_____________________________ Email ________________________
Emergency Contact
Name ________________________________________Phone______________
Medical Information
Dr._______________________________ Phone_________________________
Allergies_________________________ Special Needs: _________________
Hold Harmless Agreement
The undersigned hereby agrees to indemnify and hold William and or Sabina Andricovich, its
Agents and or its Employees and or Sabills Morgan Horse Farm LLC, harmless of any and all
claims of, injuries, death or damage to my person, and or my personal and or real property at
the property known as Sabill’s Morgan Horse Farm LLC., located at 750 Southford Road
Southbury Connecticut 06488, for any and all activities that the named participant below has
contracted with William and or Sabina Andricovich, its Agents and or its Employees and or
Sabills Morgan Horse Farm LLC, to participate on no specific date and as indicated herein.
That the participant or its Parent and or Guardian has read and understands the Connecticut
Equine Activity Statute below, and in signing the HOLD HARMLESS AGREEMENT
acknowledges that William and or Sabina Andricovich, its Agents and or its Employees and or
Sabill’s Morgan Horse Farm LLC., have not made any claims or misrepresentations as to the
soundness and or safety of the horse(s) and or equipment that have been provided to me for
my use for any and all activities such as Horse Back Riding Lesson(s) and or the Trail Ride(s)
that I have requested to participate in. That the undersigned named as participant and or is
Parent and or Guardian Hereby releases and discharges William and or Sabina Andricovich, its
Agents and or its Employees and or Sabills Morgan Horse Farm LLC, from and all claims of
injuries, death or damage to my person and or my personal property as a result from any
activities that the undersigned participates in at its own free will and with out and reservations
whatsoever.
Connecticut Equine Activity Statute
GENERAL STATUTES OF CONNECTICUT TITLE 52.CIVIL ACTIONS
CHAPTER 926. STATUTE OF LIMITATIONS
Conn. Gen. Stat. s 52-577p (1994)
S 52-577p. Assumption of risk by person engaged in recreational equestrian activates, when
Each person engaged in recreational equestrian actives shall assume the risk and legal
responsibility for any injury to his person or property arising out of the hazards inherent in
equestrian sports, unless the injury was proximately caused by the negligence of the person
providing the horse or horses to the individual engaged in recreational equestrian activities or
the failure to guard or warn against a dangerous condition, us, structure or activity by the
person providing the horse or horses or his agents or employees.
I have read the above and understand I am participating in a Horseback Riding Lesson and or
Trail Ride under my own free will and at my own Risk.
Signature and Date_________________________________________
Name (print) ________________________________________Age______
Parent or Guardian
Name (print) _____________________________________________________
Relationship to student_____________________________________________
Address_________________________________________________________
City of Town______________________________________________________
Phone_____________________________ Email ________________________
Emergency Contact
Name ________________________________________Phone______________
Medical Information
Dr._______________________________ Phone_________________________
Allergies_________________________ Special Needs: _________________
Hold Harmless Agreement
The undersigned hereby agrees to indemnify and hold William and or Sabina Andricovich, its
Agents and or its Employees and or Sabills Morgan Horse Farm LLC, harmless of any and all
claims of, injuries, death or damage to my person, and or my personal and or real property at
the property known as Sabill’s Morgan Horse Farm LLC., located at 750 Southford Road
Southbury Connecticut 06488, for any and all activities that the named participant below has
contracted with William and or Sabina Andricovich, its Agents and or its Employees and or
Sabills Morgan Horse Farm LLC, to participate on no specific date and as indicated herein.
That the participant or its Parent and or Guardian has read and understands the Connecticut
Equine Activity Statute below, and in signing the HOLD HARMLESS AGREEMENT
acknowledges that William and or Sabina Andricovich, its Agents and or its Employees and or
Sabill’s Morgan Horse Farm LLC., have not made any claims or misrepresentations as to the
soundness and or safety of the horse(s) and or equipment that have been provided to me for
my use for any and all activities such as Horse Back Riding Lesson(s) and or the Trail Ride(s)
that I have requested to participate in. That the undersigned named as participant and or is
Parent and or Guardian Hereby releases and discharges William and or Sabina Andricovich, its
Agents and or its Employees and or Sabills Morgan Horse Farm LLC, from and all claims of
injuries, death or damage to my person and or my personal property as a result from any
activities that the undersigned participates in at its own free will and with out and reservations
whatsoever.
Connecticut Equine Activity Statute
GENERAL STATUTES OF CONNECTICUT TITLE 52.CIVIL ACTIONS
CHAPTER 926. STATUTE OF LIMITATIONS
Conn. Gen. Stat. s 52-577p (1994)
S 52-577p. Assumption of risk by person engaged in recreational equestrian activates, when
Each person engaged in recreational equestrian actives shall assume the risk and legal
responsibility for any injury to his person or property arising out of the hazards inherent in
equestrian sports, unless the injury was proximately caused by the negligence of the person
providing the horse or horses to the individual engaged in recreational equestrian activities or
the failure to guard or warn against a dangerous condition, us, structure or activity by the
person providing the horse or horses or his agents or employees.
I have read the above and understand I am participating in a Horseback Riding Lesson and or
Trail Ride under my own free will and at my own Risk.
Signature and Date_________________________________________
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