Please list any additional relevant medical information by enclosing a written document with this application. By signing this application, the undersigned understands for him/herself and/or minor wards or children that there are risks inherent in being around or astride horses, ponies and equines, such as but not limited to: Falling, tripping, being bitten, stepped on or kicked by an equine or any animal on the farm or on location where this program is held. Such occurrences cannot always be foreseen. Riders, families and guests ride, participate in this Program or audit it at their own risks. The owners, managers, staff of Equishare USA, LLC / PonyShare as well as the Township and Recreation staff where this program is being held cannot and will not be held liable by the undersigned, guests, friends, relatives or family members for any occurrence that may cause mental or physical damage to themselves, their children, guests, wards and their property.

Choice of Program/Location
I wish to enroll my child in the following Program(s)

	County	Town	Location	Date	Time	Fee
1
2
3
Signed:________________________________Date:___________________

Method of Payment ( ) MasterCard* ( ) Visa* ( ) Check (Payable to: Equishare USA, LLC.)

*Card Number:________________________________ *Expiration date (Month/Year):___________/_______________

Equishare USA, LLC.  28 Fox Hill Road, Califon, NJ 07830  

Tel: (908)439-3901  Fax: (908)439-9666  Web: www.ponyshare.com