Contact's Name______________________________________________________________________ Contact's Address _____________________________________________________________________ City__________________________________________________________________ State __________ Zip __________ Contact Phone Number ________________________Email _____________________ Emergency Contact Name __________________________ Phone Number ________________________
Birthday Child’s Name____________________________ Date of Birth __________ Boy or Girl (circle one)
Expected Number of Children: _____________ Up to 10 included in base price * Add $25 per child over 10.
Age Range ________________________ Do children have any experience with horses or donkeys?
If any please explain _________________________________________________________________________________
Approximate Number of Adults remaining for party________ Note: At least one adult must remain at all parties. More adults recommended for children under the age of 8. No charge for adult chaperones to be present.
Date requested for party ____________ Time requested for party ______________
Party length requested _____________ (3 hours included in base price) *Add $50 /30 additional mins party length (depending on other bookings additional time cannot always be offered)
ALTERNATIVE DATE IF 1ST CHOICE ISN’T AVAILABLE? ___________________(We will always confirm your date and time before deposit required.)
Preference of animals in personal petting zoo (will be first event and can take between 30 mins and 2 hours depending on other activities requested) (Donkeys, Ponies, Horses) _________________________ (2/3 included in base) *Add $10 for each additional animal up to 4 in petting zoo.
Horse or Pony Ride Children are hand-walked by party hostess a few laps around the riding ring after brief instructional talk and all children meeting the horse.
Extras desired Farm themed grab bags $4 each. (for children over 3yo only) Quantity desired _______
Tattoos $15 total for all _________ (approx. 10 minutes)
Bottled Water $1 each __________
Game preference 1 game is included in base price (each take approx. 20 minutes) ____ Horseshoes ____ Cowboy Hat Throw ____ Potato Sack Race ______ Pin the Tail on the (not real) Donkey ______ Balloon Smash ____ Egg Race Ask about other games or feel free to suggest one your child enjoys. If we can accommodate, we will. * Add $25 for additional game.
Crafts (optional Add-On) *Note each craft takes about 30 minutes and prices vary depending on material costs*
_________ Painting a Real Horseshoe (add $10 per child)
_________ T-shirt Decorating (add $12 per child and provide sizes for all shirts at least 10 days in advance of your party OR add $25 for this craft for up to 10 kids and $2 for each additional child if you provide the shirts)
_________ Paint a Canvas with your favorite farm animal. Kids go home with a 8x10 canvas painted by an animal of their choice. Canvas and paint put in Ziplock and then molasses put on outside of bag.. animal eats the molasses and designs an abstract painting at the same time. It gets messy but lots of fun. (Add $6 per child)
__________Pinecone Bird Feeders (add $25 for this craft for up to 10 kids and $2 for each additional child. This is an activity and a craft. We will go look for pinecones in the woods and then decorate them with peanut butter and bird seed)
__________ Painting Wooden Letters (add $10 per child. We need 10 days’ notice of which letter(s) you will want)
__________ Decorate a Wooden Frame with ink stamps and markers or paints (decoration materials are age appropriate and TBD)
Activities (optional Add-ons) *Note times for activities depend on party group size and are based on 10 children below*
__________ Bobbing for Apples (add $25. Note children will be wet and dirty. Towels are not provided so please consider bringing changes of clothes and consider temperature at the time of the event) Approx. 30 minutes.
__________ Pinata (add $65. We will fill it with basic candy and goodies or can load with your provided goodies. If you would like to bring your own filled pinata we have a place to hang it for the party game and this will only be a $20 cost to hang and host the activity) Approx. 30 minutes
__________ Paint the White Horse (add $25. Older kids suggested but any can try! Our magical and very large white horse will be used as your canvas for your party background. This guy is friendly but feisty and fun to decorate.) Approx. 30 minutes
__________ Nature Trail Walk and Donkey Sighting (add $20. Walk through the wooded trails and find a few of the other donkeys and possibly a horse or two amongst the trees and the back areas. Find pinecones and/or branches for crafts and enjoy nature) Approx. 20 minutes
__________ Wheel Barrel Race (add $20. *kids 8 and older suggested* This will need to be done with kids strong enough to push each other in a wheel barrel) Approx. 25 minutes
__________ Fire Pit and S'mores (add $50. *kids 8 and older only*) Approx. 45 minutes
__________ Night Time LED Light and Fire Pit Party (add $200 or coordinate directly for a custom party experience. *For kids 12 and over only*) Approx. 2 hours
ESTIMATED PARTY TOTAL COST: DETAILS:
BASE PARTY $_________ _____________________________________________
EXTRA GUESTS $_________ _____________________________________________
ADD ONS $_________ _____________________________________________
EXTRA ANIMALS $_________ _____________________________________________
EXTRA GAMES $_________ _____________________________________________
CRAFTS $_________ _____________________________________________
ACTIVITES $_________ _____________________________________________
OTHER $_________ _____________________________________________
50% DEPOSIT $_________ DATE PAID _____________ RECEIVED BY: ___________
BALANCE DUE $_________
PARTY DAY ADD ONS $_________ --------------------------------------------------------------------------
FINAL DUE PARTY DAY $__________ DATE PAID _____________ RECEIVED BY: ___________
(ADD 3.5% IF CREDIT /DEBIT CARD USED)
CREDIT CARD PAYMENTS COMPLETE BELOW
Account Type: [ ] Credit [ ] Debit
Exp Date: _______ CV:_____
** Take picture of front and back of card or process through website **
Account Owner Signature: _____________________________________________
Birthday Party Guidelines Agreement
I agree to abide by all terms and conditions set forth in the Birthday Party Guidelines Agreement and that failure to adhere to these regulations will incur financial penalties and possible legal actions.
Please read this carefully and be aware that in signing up and participating in this program/activity, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this program. I recognize and acknowledge that there are certain risks of physical injury to participants in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in this program/activity against the farm including its officials, agents, program instructors, volunteers, and employees. I hereby authorize and give my consent to the district to photograph/video my child (or me), and without limitation, to use such photographs/video in connection with promoting/advertising the services, programs, without consideration of any kind. I have read and fully understand the above important information, warning of risk, assumption of risk, waiver and release of all claims, and photo/video authorization. If registering online or via email, my online signature shall substitute for and have the same legal effect as an original form signature.
DEPOSIT & PAYMENT
• 50% non-refundable deposit is required to secure the reservation. If you need to reschedule, we will try our best to work with you to find an alternate date/time. If you are unable to reschedule or accept credit toward a future party, you agree to forfeit your deposit. Rescheduling must be done 14 days in advance to retain a full credit unless we can book another event at your cancelled time.
• Remaining 50% plus add-ons, options and extra guests shall be paid upon arrival for event on day of party. Cash or check preferred. Credit cards can be processed but will incur an additional 3.5% credit card fee. Note all taxes, fees, and add ons will be collected before party begins on day of event or sooner.
• Please advise your guests and their parents to review the Equine Release /Waiver located at the bottom of every page on our website and attached to this form. Please make every effort to have all guests sign waivers prior to attendance. All guests without fully executed waivers will be included in the waiver above and considered your “ward” for this event.
• Please be sure that the party area is cleaned up, garbage is placed in the garbage cans and that the area is vacated by guests at the conclusion of the event. A $50 fee will be added if decorations are left and/or trash is not placed in the trash cans before departure.
• Birthday parties are held at covered area off barn close to the petting zoo and riding area unless another request is made. When inclement weather, party can be held in barn or pavilion.
• Each party reservation includes a 15-minute set-up and 15-minute clean-up time. Your party hostess will assist with this.
• Items including decorations or other event materials may not be left after your event.
I have read and fully understand the agreement and Equine Release and Waive of Liability and take full responsibility for all guests invited to this event. I understand that each guest should complete the Equine Release and Waiver. I have read and signed the attached waiver on behalf of all minors/wards and guests that have not completed their own individual waiver.
Printed Name: __________________________________________
Signature: ______________________________________________ Date:______________________
EQUINE RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT
"Equine" means a horse, pony, mule, donkey, or hinny.
"Inherent risks of equine activities" means those dangers or conditions that are an integral part of engaging in an equine activity, including any of the following:
a. The possibility of an equine behaving in ways that may result in injury, harm, or death t persons on or around them.
b. The unpredictability of an equine's reaction to such things as sounds, sudden movement, unfamiliar objects, persons, or other animals.
"Participant" means any person, whether amateur or professional, who engages in an equine activity, whether or not a fee is paid to participate in the equine activity.
By signing this Equine Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement (Release), I represent that I have read this agreement and that I fully understand agreement. These Equine activities involve the risk of serious bodily injury including but not limited to permanent disability, paralysis and even death. I represent that I am in good health and in proper physical condition to participate in these activities. I understand the nature and risk of participating in Equine activities. I understand that this release is intended to include all activities whether on or off the equine.
I have read this EQUINE RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY
AGREEMENT from Dawn Berard, Riptide Stables, 4220 Buck Drive, Castle Hayne, NC 28429, and I understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature. I intend this to be a complete and unconditional release of all liability to the greatest extent allowed by law which includes employees, officers and contract employees of Dawn Berard, Riptide Stables and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect. I further agree to indemnify, defend and hold Dawn Berard, Riptide Stables, and their officers, directors, employees, and agents, harmless from any liability relating to personal injury or injury to real or personal property of any kind arising out of the ordinary negligence, willful or wanton negligence, or intentional acts of the undersigned.
This Release is governed by the law of the State of North Carolina. By signing this agreement, I agree to be the exclusive jurisdiction of the courts of the state of North Carolina, and that the only venue for any legal proceedings shall be New Hanover County, North Carolina.
Printed Name of Participant: ______________________ Participant Age:_____
Signature of Participant: __________________________ Date_________________
Phone Number ___________________
PARENTAL CONSENT (Only needs to be signed and dated if the participant is under the age of 18)
I, _______________________ the minor’s parent and/or legal guardian, understand the nature of the above-referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I have read and understand the above EQUINE RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AGREEMENT.
Printed Name of Parent/Legal Guardian
_________________________________________ Date: __________________
Signature of Parent/Legal Guardian Emergency Phone # (___)