Angelica Run Farm
Home of the "Pony Pool"
1927 Hunter Mill Road
Vienna, VA 22182

Financial Information:

Lessor Name(s):
Responsible Party (MUST be age 18+):
Social Security Number:-- Date of Birth: //
Home Phone: Business Phone:
Emergency Phone: Cell Phone:

Email Address: Rider's Name:
Health Insurance Company:
Policy of Group Number:Phone:
List any Medical Information we should be aware of in the event of serious injury:
Name & Number of person to contact in emergency if you cannot be reached:

1) All Board must be paid monthly in advance, on the first day of each month. A late charge of $10 will be charged on all board not received by the fifth (5th) day of each month. The monthly boarding charge is $ per month, for rides per week.

In addition, Lessor agrees to pay the bi-annual Fall and Spring Maintenance Fee listed on the web page that due on April 1 and October 1 respectively. The Fall and Spring Maintenance Fee will be pro-rated and due upon acceptance to the Pony Pool.

Lessor understands that missed weekly rides cannot be made up.

2) The Lessor agrees to give at least thirty-five days written notice, no later than the 25th day of the second to last month that payment is needed, prior to departure. (For example, written notice given at any time between September 1st and September 25th means that the last full month of payment desired is October. Full payment must be made through October.

3) Rates are subject to increase.

4) Angelica Run Farm, Inc. and all its employees and agents shall not be liable for damages which may accrue from any cause growing out of or as a result of the boarding of the animal including but not limited to loss by fire, theft, running away, wind, flood, or other inclement conditions, or injury or death to persons, animals, or damage to property.

5) The lessor agrees to abide by all the rules and regulations of the stable which are posted, and to inform all agents and invited guests that such rules are posted.

6) This agreement consists of both this document and a written release of Angelica Run Farm, Inc., its agents and employees, from responsibility for engaging in the inherently dangerous activities of handling equines, signed separately by the equine owner on the day of , 20. These two documents comprise the entire agreement between the two parties.

7) The animal lessor releases and expressly agrees to indemnify Angelica Run Farm, Inc., and all its employees and agents from any and all claims, demands, actions or suits at law or in equity, of any kind in nature, including negligence, by anone the animal lessor has authorized express or implied, to handle the animal on the premises or authorized or invited to enter on the premises for an equine activity or activity collateral to handling an animal.

8) Waiver or any breach of this agreement shall not be held to be a waiver or any or subsequent breach of this agreement.

9) This agreement shall remain in effect until subsequently revoked in writing by the parties.

Agreed to this day of , 20.

Please Print Name:
For Angelica Run Farm, Inc.

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