YOUTH CAMP | CAMPER INFORMATION FORM & PARTICIPATION AGREEMENT

Child’s First & Last Name:                        

Camper's Age:   Date of Birth:  

Current residence:               

Camp Week(s) Registered For:

 

Camper's Previous Horse Experience: (If none, please write "none")

Guardian/Emergency Contact Information:

Primary Guardian:  

Primary Guardian's Email Address:  

Primary Guardian's Phone Number:  

Other Person(s) Allowed to Pick-up Camper:  


Emergency Contact (Parent or Legal Guardian):

Emergency Contact Phone:  


Secondary Emergency  Contact:

(Other than Parent Above):      

Secondary Contact's Phone:        

Secondary Contact's Email Address:  

Primary Care Physician or other medical care provider:         

Primary Care Physician or other medical care provider's Phone #:  

HEALTH INFORMATION:

Camper's Height:  Camper's Weight:

Date of Camper's Last Tetanus Booster:  

Any specific health needs or diet restrictions our staff needs to be aware of?

Is the Camper currently on any Medications?

Any allergic reactions to drugs/medication, insects, plants, animals, food...etc?


 

Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware? 


If yes, please explain health problems and any considerations:          


Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child’s camp experience is positive?


 

IMMUNIZATION INFORMATION:

For campers who currently reside within the United States, a United States territory, or the District of Columbia: Does the camper have any immunization exemptions because of a parental or guardian objection or medical contraindication?

 

For campers who reside outside the United States, a United States territory, or the District of Columbia:

Attach  Department Form MDH-896 with child's record of vaccination or immunity to your camp registration.

Emergency Policy Agreement

In case of emergency, I understand that every effort will be made to contact me.  However, if I cannot be reached, I hereby give permission to the physician selected by employees of Horse & Hive to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child named above. 
Be sure to check in on the first day with the camp instructor and exchange contact information so that both parties can reach one another if in need.

  I agree to the above emergency policy.

MDH-4768 (06/2020)

Camper Participation Agreement

On behalf of Child/Participant, Parent/Guardian hereby agrees to the following:


Camp starts at 9:00am and ends at 4:00pm (before and after childcare can be provided upon request).

Each camp participant is expected to participate in barn chores associated with riding and caring for camp horses.
This includes but may not be limited to: sweeping, filling and dumping water buckets, filling hay nets, mucking (cleaning stalls), cleaning equipment, grooming and bathing horses.



ATTIRE: Wear long pants, shirt or polo shirts and boots with low heel while riding.
 NO riding in shorts, tennis shoes, or sandals. Closed toe shoes must be worn at ALL times in the barn and around animals – shoes may only be removed during water activities. Bring an extra set of clothing (this can be stored and left at camp all week unless used and in need of being replaced). Bring a bathing suit each day and towel.



FOOD/DRINK: Bring lunch, snacks, and water daily – as much as the camper should need all day. Please note: we are a nut free farm, no nut products are allowed at camp.



SAFETY: Respect safety rules indicated by instructors at ALL times (no running around horses, no standing behind horses, etc....please refer to our lesson policy agreement for additional rules and policies). No fire, firearms, alcohol, or drugs permitted on premises.
A signed liability release form for camper must be on file.
Have a positive attitude towards horses, other campers, and instructors.

 I agree to the Camp Participation Agreement.

DIGITAL MEDIA RELEASE & WAIVER:  I agree Horse & Hive Farm may use my or my child’s likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand Horse & Hive never posts names or other identifiable information when using digital media in any form unless we have previous permission from the subject(s). 

Join H&H's email list and stay up-to-date with horse riding tips, news, events, camps, activities and more.

The parties agree that this agreement and all information provided therein may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposed of validity, enforceability, and admissibility. 

Date Signed: April 24, 2024

Signature below must be Parent or Legal Guardian.

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Document name: Horse & Hive Farm | Youth Camp- Camper Information Form
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May 26, 2023 6:18 AM EDTHorse & Hive Farm | Youth Camp- Camper Information Form Uploaded by STRIDER Team - support@striderpro.com IP 74.96.94.142
June 5, 2023 8:45 AM EDTStrider Waivers - waivers@striderpro.com added by STRIDER Team - support@striderpro.com as a CC'd Recipient Ip: 74.96.94.142
June 5, 2023 8:58 AM EDTStrider Waivers - waivers@striderpro.com added by STRIDER Team - support@striderpro.com as a CC'd Recipient Ip: 74.96.94.142
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June 5, 2023 9:11 AM EDTHorse and Hive Farm - hhfarm2012@gmail.com added by STRIDER Team - support@striderpro.com as a CC'd Recipient Ip: 74.96.94.142
June 5, 2023 9:18 AM EDTStrider Waivers - waivers@striderpro.com added by STRIDER Team - support@striderpro.com as a CC'd Recipient Ip: 74.96.94.142
June 5, 2023 9:18 AM EDTHorse and Hive Farm - hhfarm2012@gmail.com added by STRIDER Team - support@striderpro.com as a CC'd Recipient Ip: 74.96.94.142
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