2023–2024

Program starts Saturday September 9th 2023

In addition to basic background information, to complete this form you’ll need:

Digital photos to upload for each child being registered (if you choose to submit)
Family doctor and dentist information
Health insurance information (provider and insurance number)

"*" indicates required fields

Step 1 of 5

Parent/Guardian Information

Parent/Guardian 1 Name*

First Last

Parent/Guardian 1 Phone (Day)*

Parent/Guardian 1 Phone (Evening)*

Parent/Guardian 1 Email*

Parent/Guardian 2 Name (if applicable)

First Last

Parent/Guardian 2 Phone (Day)*

Parent/Guardian 2 Phone (Evening)*

Parent/Guardian 2 Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Would you like to be listed in the Member Directory (available to Members only)?*

Yes

How many Students are you registering for Equine Care Only?*

How many Students are you registering for the Horsemanship program?*

Is this the family's first time registering for NCMT's Horsemanship program?*

Note that registering for our summer camp is NOT the Horsemanship program.

Number of Total Students (calculation) – invisible

Check any that apply:

My family is applying for a scholarship

My family has been approved for a scholarship

Each year, NCMT offers a very limited number of need-based scholarships. Tax, financial and other information is required to complete the application. You will be sent a link to the scholarship application form upon completion of registration. Note that registration/scholarship is not confirmed until you receive formal notification.

Student Medical & Emergency Contact Information

Did you submit a state health form as a participant in NCMT's 2023 summer program?*

Yes

NOTE: State Medical Form Required
In addition to the medical and emergency contact information provided below, each Trooper is required to have a state health form prior to the start the program.

If you have already submitted this form to school for the 2022-2023 school year, a copy of that form is fine.

If you need a blank form, you can download it here. A link to the document will also appear in your confirmation email.

Emergency Contact Name (other than parent/guardian)*

First Last

Emergency Contact Phone*

Relationship to Student(s)*

Physician Name*

First Last

Physician Phone*

Dentist Name*

First Last

Dentist Phone*

Medical Insurance Carrier*

Medical Insurance Policy Number*

Please add any notes about your child’s medical needs or anything else we should know about their history.

Parent/Guardian Medical Treatment Consent Signature*

I AUTHORIZE THE STAFF OF NEW CANAAN MOUNTED TROOP, INC., TO SIGN FOR THE ADMITTANCE AND TREATMENT OF THE PERSON(S) INCLUDED IN THIS REGISTRATION AT AN EMERGENCY MEDICAL TREATMENT FACILITY, IN THE EVENT THE PARENT/GUARDIAN IS NOT AVAILABLE. ALL INFORMATION SUBMITTED WILL BE HELD STRICTLY CONFIDENTIAL. IF THERE IS A CHANGE IN THE ABOVE INFORMATION, I WILL NOTIFY NCMT IMMEDIATELY.

Printed Name (for Medical Consent)*

Warning, Indemnity, Hold Harmless and Release of Liability

All registrants must agree to the following terms.

WARNING

Pursuant to Connecticut General Statutes §52-557p, a person engaged in recreational activities assumes the risk and responsibility for any injury to his or her person or property arising out of the hazards inherent in equestrian sports, unless the injury was caused by the negligence of the person providing the horse/pony or horses/ponies to the individual engaged in the equestrian activities, or the failure to guard or warn against a dangerous condition, use, structure or activity of the person providing the horse/pony and/or horses/ponies, or his or her agents and or employees.

ACKNOWLEDGEMENT

I, and/or on behalf of my child listed below, understand that there is an inherent risk in equestrian sports, including but not limited to the risk of serious physical injury, loss and/or death. However, I feel that the possible benefits for myself /my child /my ward are greater than the risk assumed. I, on behalf of myself /my child /my ward, fully assume all risks associated with equestrian sports, including Therapeutic Riding Programs, even if due to the NEGLIGENCE of New Canaan Mounted Troop, Inc. (hereinafter referred to as “NCMT”), and any of its instructors, Therapeutic Riding instructors, or guest instructors invited by NCMT, its Officers, Directors, Agents, Volunteers and/or Employees, including but not limited to variations in the indoor and outdoor ring conditions; man-made obstacles; collisions with object either inside or outside the riding rings including but not limited to jumps, hay bales, shrubbery, rocks, equipment, employees, participants, or other patrons and spectators on the property; lack of safety devices, or inadequate safety devices; lack of warning or inadequate warning; lack of instruction or inadequate instruction. I, on behalf of myself / my child / my ward, am responsible for immediately informing NCMT of any mental, physical or other condition, or change in condition, that may affect my child’s ability to participate in equestrian sports, including Therapeutic Riding Programs.

HORSES & PONIES

I, or on behalf of my child listed below, understand that horses and ponies, although tamed, trained and boarded at NCMT are in fact a “wild” animal, and may buck, shy, spook, kick, bite and/or react unexpectedly to the actions of other horses or ponies, riders, employees of NCMT, and environmental effects including but not limited to noise, wind, light/darkness, or any man-made or environmental anomaly beyond the control of NCMT, its instructors, guest instructors, Officers, Directors, Agents, Volunteers and or Employees.

INDEMNIFICATION

I, or on behalf of my child listed below, for myself and for my heirs, assigns, successors, executors, administrators and legal representatives, agree that I will defend, indemnify and hold harmless, NCMT and any of its instructors, Therapeutic Riding instructors, or guest instructors invited by NCMT, its Officers, Directors, Agents, Volunteers and/or Employees, free from any and all claims, suits or demands by anyone arising from my use of the facility, equipment and/or horses/ponies owned by, boarded at NCMT, or brought onto the property owned by NCMT, including claims of NEGLIGENCE on the part of NCMT and any of its instructors, Therapeutic Riding instructors, or guest instructors invited by NCMT, its Officers, Directors, Agents, Volunteers and/or Employees.

RELEASE

I, or on behalf of my child listed below, for myself and for my heirs, assigns, successors, executors, administrators and legal representatives, hereby release and agree that I will not sue NCMT and any of its Instructors and Employees, its Therapeutic Riding Instructors, or guest instructors, its Officers, its Directors, its Agents, its Volunteers, and/or other guests invited by NCMT, for money damages and/or for any injury, loss and/or death, emotional distress, or from theft to person, horse/pony or possession, sustained by me while using the facility, equipment and/or horses/ponies owned by, boarded at NCMT, or brought onto the property owned by NCMT, even if due to the NEGLIGENCE of NCMT and any of its instructors, Employees, its Officers, Directors, Agents, Volunteers, Therapeutic Riding Instructors, or guest instructors or other guests invited by NCMT. This hold harmless agreement shall extend to all activities engaged in including but not limited to horseback riding activities and any exposure or resulting illness or death from any communicable disease, including Covid-19 or biological agent.

Student 1 Name (for Waiver)*

First Last

Student 1: Parent/Guardian or Camper (if 18 or older) Waiver Signature*

WARNING, INDEMNITY, HOLD HARMLESS & RELEASE OF LIABILITY
I have read this WARNING, INDEMNITITY, HOLD HARMLESS and RELEASE OF LIABILITY and fully understand its terms. I further understand that by signing this agreement that I may be waiving specific legal rights, either for myself or for my undersigned child on whose behalf I am signing this agreement. I have not been induced to sign this agreement and have not signed pursuant to any promise or representation which has not been attached hereto, if any. I sign said agreement voluntarily and of my own free will.

Student 2 Name (for Waiver)*

First Last

Student 2: Parent/Guardian or Camper (if 18 or older) Waiver Signature*

Student 3 Name (for Waiver)*

First Last

Student 3: Parent/Guardian or Camper (if 18 or older) Waiver Signature*

Photo/Media Release

Photo/Media Release: Approve/Decline*

Do you consent to the following?

I grant to New Canaan Mounted Troop, Inc., (“NCMT”) its representatives and employees the right to take photographs or videos of my child/children or myself (“my family”) in connection with my family’s activities associated with NCMT. I authorize NCMT, its assigns and transferees to copyright, use and publish the same in print and/or electronically as part of its advertising, publicity, fundraising efforts or other uses. I understand that NCMT will not compensate my family for such use and hereby waive any right to inspect and approve the use to which it may be applied.

Approve

Decline

Notes/Comments on Photo/Media Release

Photo/Media Release Signature*

Printed Name of Photo/Media Release Signer*

Registration Submission (No Payment, Scholarship Applicant/Recipient)

Registration Submission

Submit your program registration below. Remember, if you haven’t been approved for a scholarship, this registration is not confirmed until a completed scholarship application has been submitted and awarded/approved by NCMT.

Payment Schedule

Dues and fees are due in full upon registration, but you can pay your tuition balance in installments. How would like to pay your tuition balance?*

Installment payments will automatically be billed to your credit card every 75 days from the date of registration until the amount is paid in full.

Pay in full today

Pay in four equal installments

NCMT 85th Anniversary

As we approach our 85th year, please consider a contribution to our 85th anniversary scholarship fund. NCMT’s board of directors annually provides financial support through scholarships, to at least 10% of students in our horsemanship program and 30% of students in our therapeutic program making our programs more accessible. Please help us reach our goal for the scholarship fund of $10,000.

NCMT 85th Anniversary Donation*

Count me in for $100.00

Count me in for $250.00

Count me in for another amount.

Other donation amount:

Payment Details

New Member Fee*

The new member fee includes an NCMT jacket.

Price:

Annual Dues/1 Student, Horsemanship*

Price:

Annual Dues/2 or more Students, Horsemanship*

Price:

Annual Dues/1 Student, Equine Care*

Price:

Annual Dues/2 Students, Equine Care*

Price:

Student 1 Tuition

Student 2 Tuition

Student 3 Tuition

Total Tuition

NCMT 85th Anniversary Donation

Total

Installment Payment Details

The new member fee (if applicable) and annual dues are payable at the time of registration. The tuition balance will be charged to your credit card in four equal installments every 75 days until paid in full.

New Member Fee

Annual Dues, 1 Student/Horsemanship

Annual Dues, 2 Students/Horsemanship

Annual Dues, 1 Student/Equine Care

Annual Dues, 2 Students/Equine Care

Student 1 Tuition

Student 2 Tuition

Student 3 Tuition

Total Tuition

NCMT 85th Anniversary Donation

Total Dues/Fees Due Today

Price: $0.00

Today's Tuition Installment Payment Due (1st of 4 Total)

Price: $0.00

TOTAL CHARGED TODAY

Note that dues/fees and tuition are charged in separate credit card transactions based on the totals listed above.

Payment Information

I have read and agree to the terms of the cancellation policy*

If a Student withdraws within 30 days of their first lesson, payments are refundable, less a administrative fee equal to 25% of all fees, dues and tuition. After 30 days, registrants are responsible for the full fees, dues and tuition. Exceptions are made for withdrawal due to medical injuries that are certified by a note from a physician (fees, dues and tuition will be prorated based on remaining program term). Installment payments will be billed to the card submitted with this registration. It is the responsibility of the registrant to notify the Troop office of any changes to credit card information. Students are eligible for one make up lesson per term. There are no refunds for missed lessons/barn days.

I have read and agree to the terms of the cancellation policy

Credit Card*

Total

Phone

This field is for validation purposes and should be left unchanged.

Register: Horsemanship and Equine Care

2023–2024

Parent/Guardian Information

Student 1

Student 1 Lesson Scheduling

Student 1 Barn Day Scheduling

Student 2

Student 2 Lesson Scheduling

Student 2 Barn Day Scheduling

Student 3

Student 3 Lesson Scheduling

Student 3 Barn Day Scheduling

Student Medical & Emergency Contact Information

Warning, Indemnity, Hold Harmless and Release of Liability

Photo/Media Release

Registration Submission (No Payment, Scholarship Applicant/Recipient)

Registration Submission

Payment Schedule

NCMT 85th Anniversary

Payment Details

Installment Payment Details

Payment Information