Kids & Horses Summer Day Camp

Our 2023 Kids & Horses Summer Day Camp is targeted for children with and without disabilities between the ages of six-sixteen. Campers must have basic self-help skills, they must be toilet trained and have positive social behavior.

Participant's Name (first and last): *

Age: *

DOB: *

Gender *

Male

Female

Diagnosis/Diagnoses (if applicable): *

Height: *

Weight: *

T-Shirt Size (Youth XS-XL or Adult S-XL): *

Allergies: *

Medications: *

Parent or Legal Guardian: *

Mailing Address: *

Phone Number: *

Email Address: *

Preferred Method of Contact: *

Phone

Either

Payment

The cost for the Kids & Horses Summer Day Camp is $325 per participant. This includes all the planned activities for all five days. Kids & Horses is accepting payments online through Paypal or by check, cash, or credit card in-person at the Kids & Horses office. All payments are due by July 10th, 2023.

Kids & Horses will provide full refunds for participants up until July 1st, 2023. After July 1st, 2023, Kids & Horses will require a portion of the registration fee to cover the supplies already purchased for the participant. Please notify the office right away with cancellations.

Plan of Payment: * 🛈

Paypal

Kids & Horses Office

Doctor's Release

Our summer camp program provides a variety of activities. Riding the horses will a portion of the program toward the end of the six sessions. Participants with a diagnosis MUST have a Doctor's Release submitted to Kids & Horses to ride one of our therapy horses. Those who do not have a Doctor's Release WILL have other opportunities to groom and work with the horses on the ground.

I do NOT plan on submitting a Doctor's Release.

I plan on submitting a Doctor's Release.

Kids & Horses already has my child's 2023 Doctor's Release on file.

Liability Release

Participant's Name: *

would like to participate in the Kids & Horses Summer Day Camp. I acknowledge the risk and potential for risks of horseback riding and being around horses. However, I feel that the possible benefits to my son/daughter, my ward, or myself are greater than the risk assumed. I, hereby, intend to be legally bound for myself, my heirs, and assigned executors or administrators. I waive and release, forever, all claims for damages against Kids & Horses Therapeutic Riding Center, its Board of Directors, Instructors, Therapists, Aides, Volunteers and/or Employees for any and all injuries and/or losses, my son/daughter, my ward or I may sustain while participating in the Kids & Horses Summer Camp program.

Signature of Parent/Legal Guardian *

clear

Date: *

Policy of Confidentiality

I agree to respect and observe privacy and confidentiality of the participants, volunteers and donors of Kids & Horses, Inc. and not discuss any sensitive information about any person or their family.

Signature of Parent/Legal Guardian *

clear

Date: *

Photo Release

Participant's Name: *

I consent to authorize the use and reproductions by Kids & Horses Therapeutic Riding Center of any and all photographs and any other audiovisual materials taken of me or my child for promotional printed material, education activities, exhibitions, website, social media, or for any use for the benefit of the program.

I do NOT consent nor do I authorize the use and reproductions by Kids & Horses Therapeutic Riding Center of any and all photographs and any other audiovisual materials taken of me or my child for promotional printed material, education activities, exhibitions, website, social media, or for any use for the benefit of the program.

Signature of Parent/Legal Guardian *

clear

Date: *

Authorization for Emergency Medical Treatment for Particpants

Participant's Name: *

In case of emergency contact:

Name: *

Relation: *

Phone: *

Name: *

Relation: *

Phone: *

Physician's Name: *

Phone: *

City: *

Preferred Medical Facility: *

Health Insurance Carrier *

Policy #: *

Consent Plan:

I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication and any treatment procedure deemed “life saving” by the physician). In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services, any participation on my part at Kids & Horses, Inc., or while being on the property of Kids & Horses, Inc., I authorize Kids & Horses, Inc. to :

Secure and retain medical treatment and transportation, if needed.
Release records upon request to the authorized individual or agency involved in the medical emergency treatment.

NON-Consent Plan: I do NOT consent for emergency medical treatment/aid in the event of illness or injury during the process of receiving services, any participation on my part at Kids & Horses, Inc. or while being on the property of Kids & Horses, Inc. In the event emergency medical treatment/aid is required, I wish the following procedures to take place: *

Signature of Parent/Legal Guardian *

clear

Date: *

Safety Rules

1. Please have participants wear long, comfortable PANTS and CLOSE-TOED shoes, preferably heeled boots. If the child does not wear long pants, the participant will NOT be allowed to ride, but there will be alternate activities.

2. Please obey the 25 MPH speed limit on Esaw Street and 10MPH on the ranch property.

3. Please drop off and pick up your child at the set times and do not expect Kids & Horses staff or volunteers to assume responsibility for the participant prior to or after the appropriate, set time (8:15 am -12:00 pm).

4. Please do NOT pet or feed horses without Kids & Horses staff supervision.

5. ASTM-SEI helmets (provided) must be worn by participants when grooming, handling, or riding a horse.

I have read and understand the safety rules.

Signature of Parent/Legal Guardian *

clear

Date: *