NADY Horseback Riding Program 2011 by xumiaomaio


									                         NADY Horseback Riding Program 2011
              Please read this page and then complete and return the registration form.

This program is for any child (6 years and up) who has a diagnosed disability or special need and has a
current NADY membership. NADY and Rotary4Kids offers to pay no more than a total of $200
(approximately 8 lessons). Any expenses beyond $200 will be the rider’s responsibility. All riding
establishments will have their own waivers, policies and rules of conduct. You are responsible for
cancelled or missed lessons as per your agreement with that stable.

Other Responsibilities:
   1. Pick an approved riding establishment from the list provided below. If you have another to
       suggest, please list it.
   2. Confirm with NADY by returning the registration form to the address provided.
   3. Arrange your lesson times with your chosen stable and your transportation to and from the stable.
   4. Ensure participant is accompanied by an adult – this is not a drop-off program.

If you have any questions, please contact us:
        NADY Office – 705.476.5437 *3550 OR
        Joanne Welton – 705.494.8199


              Brush’s Equestrian                           Rock Road Acres
              c/o Mike & Adele                             c/o Jennifer Serson
              495 Widdifield Station Rd                    119 3rd Line South
              North Bay, ON                                Bonfield, ON
              705-472-2696                                 705-776-7940

              Stoneoaks                                    On The Farm Riding Stables
              c/o Renee Lavatoire                          c/o Colleen Maxwell
              720 Southshore Road                          Calvin Township RR#2
              Astorvile, ON                                Mattawa, ON
              705-752-2437                                 705-776-2173
              Email:             Email:
                           NADY Horseback Riding Program 2011
                                            Registration Form

                              Please complete the following and send it to:
                                    NADY Horseback Riding Program
                                            One Kids Place
                                        400 McKeown Avenue
                                        North Bay, ON P1B 0B2

Participants Name: __________________________________________________________________
Birth Date: _____________________________________________ Age: ______________________
Parent/Guardian: ___________________________________________________________________
Address: __________________________________________________ Postal Code: ______________
Phone Number: _____________________________________________________________________
Emergency Contact: _________________________________________________________________
Nature of Disability: _________________________________________________________________

Please select one:              New Rider                    Returning Rider
I am interested in doing my lessons at: ___________________________________________________

Photograph Consent: I hereby consent my son/daughter’s participation in audio-visual/photo
sessions taken by the NADY program for promotion of its charity and community events.

Parent/Guardian Signature: ___________________________________________________________
Date: ______________________________________________________________________________

   If you are interested in supporting our programs by working bingos, please contact Lucie Ricci at

                     For insurance reasons, all families must have a NADY membership.

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