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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 firstname.lastname@example.org Joanne Welton – 705.494.8199 EXAMPLES OF STABLES IN THE NORTH BAY AREA 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 Email: email@example.com 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: firstname.lastname@example.org Email: email@example.com 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 705.497.3246 For insurance reasons, all families must have a NADY membership.
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