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Registration Form/Parent Guardian Agreement

 

In order to prevent parents from needing to fill out a registration and waiver form every time we are used for a class, this form will cover all our programs. You may be asked questions that do not apply to the current program you are signing up for. Please understand that as a Ranch and Farm it is possible that your child will have exposure to any or all of our other programs that use animals or materials presented in this form even if your current class is just for math.

Just a reminder that registration is a 2 step process.You must pay using the add to cart feature on the website and you must fill out this registration form, unless you are paying for horse lessons. Horse lessons are paid at the time of your first lesson. We can only take cash at this time for horse lessons. You can pay for each lesson each time or prepay for as many as you would like. 

 An email will be sent to you after the completion of this form with important information regarding camp. Please check both your junk and spam folders if you do not see the email in your general box. You must use the same valid email address for your payment and for this form and it must be an email address you check regularly

Students are expected to follow all program rules and behave appropriately as such refunds cannot be given if a student is asked to leave for infraction of a program rule or disruptive behavior or if a child is voluntarily withdrawn. 

Children attending "Follow the Child" on the Farm and or Party Ponies and Friends must be able to:

   *Move daily on foot on uneven, outdoor terrain and negotiate natural obstacles, such as trails and hills.

   *Lift and carry an item such as a small backpack.

   *Follow directions and participate willingly in camp activities.

   *Refrain from violence, hitting, verbal assault, bullying, or any similar behavior.

   *Listen well, show respect for others, work, play and interact in large and small groups without constant one-on-one assistance.

   *Abide by all camp rules as explained by camp staff.

   *Promptly notify Staff of any health condition that requires medical attention.

I acknowledge that the information provided on the registration form is complete and accurate. Initialing the agreement box below I am legally signing this agreement and understand that it is legally binding, as such, I am confirming that my child is capable of meeting the participation requirements outlined in this form.

It is important that we know of any physical, mental, or emotional condition that could affect the safety of the applicant, other students, or staff. I understand that if I fail to disclose such information and my child’s undisclosed physical, mental or emotional condition adversely affects other students, my child and/or staff, my child may be asked to leave the program and the tuition will not be refunded.

In order to limit the risk of possible covid illness we require that all students are school ready. Meaning students must be able to perform daily tasks independently. They must be able to dress themselves for outdoor activities, put shoes on, coats, snow pants, gloves, hats etc for winter outdoor activities. Students must be potty trained and able to use the bathroom independently. Please understand this is for the health safety of your child as well as other students and our staff.

We do not require masks.the choice to use a mask is purely at the discretion of the participating families..

Tuition is nonrefundable. Once we have reserved your camp spot we are turning away other students. In the event that your camp week is unable to to open due to a covid related restriction, your tuition will be applied to the next safe available camp date that meets your schedule.  Each summer, we have approximately 13 weeks of summer camp with 26 different camp options. By initialing you are stating that you have read our payment policy and understand it. We do our very best to accommodate parents in various situations and our payment policy is clearly displayed on our website. Unfortunately we can not hold spots at programs for those that do not intend to come. We are bound by capacity rules with the American Camp Association and therefor when we hold your spot in a program we are turning away another student. It is for these reasons that we ask parents to confirm their summer schedules before reserving with us. For the same reasons listed above we are not able to move students from the week they have registered into another week unless that other week has a low enrollment. The week you register for is the week we are expecting your student to attend. There is a $50 fee for each child in the event that you need to move a child to a different week. This covers our time emailing and calling parents to see if they are willing to trade weeks with your child.

Parents are responsible for the destruction of summer camp property.  If your child engages in violent behavior and destroys summer camp property you will be asked to replace it.  The destruction of property is not the same as normal where and tear.  Most items purchased for summer camp are expected to last more than one year unless it is a consumable material. As such if your child destroys such property we expect both parents and students to behave in an ethical and honorable fashion and to replace the item. We thank you in advance for your cooperation.


*Allergy Information:

Though we are not a public school we follow safety guidelines for public education. Your child's safety and well being is our highest priority while they are enjoying camp activities therefor If your child's allergy requires the use of an epipen your child must know how to administer this on his/her own. And the following must be provided per Article 3Sec. 14.30.141.  Self-administration and documentation of medication.

 (a) A public school shall permit the self-administration of medication by a pupil for asthma or anaphylaxis if, during the current school year, the pupil’s parent or guardian provides the school

    (1) written authorization for the self-administration of the medication; By initialing number 1 of this section I am giving my written authorization for my child as described in the camp information portion of this document to self administer their epipen/inhaler should an emergency arise.

    (2) written certification from the pupil’s health care provider that the pupil

         (A) has asthma or a condition that may lead to anaphylaxis;

         (B) has received instruction in the proper method of self-administration of the medication; and

         (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;

    (3) a release of liability for the school and its employees or agents for injury arising from the self-administration or storage of the medication;

    (4) an agreement to indemnify and hold harmless the school and its employees or agents for any claims arising out the self-administration or storage of the medication;

    (5) a written treatment plan for the pupil that is signed by the pupil’s health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; and

    (6) any other documentation required by the school that is consistent with this section.

By signing here I acknowledge the requirements of 2-6 regarding my child's use of an epipen/inhaler while at summer camp and agree to follow these requirements by signing the release of liability below and providing the above documents to the summer camp prior to my child's first day

*Substitute Teacher Information:

We make every effort to ensure that your child will have the same camp teacher for the full duration of the program you have selected. Unfortunately illness does occur. In the event that your child's' teacher becomes unavailable for any circumstance "Follow the Child" will provide an appropriate substitute during your regular teachers absence. All staff and affiliates of "Follow the Child" are required to submit to an interested persons report and provide this report to "Follow the Child" its affiliates, the Anchorage School District and the Matsu Borough. By initialing here you are agreeing to accept an appropriate substitute in the event your camp week or day requires one.

*Drop off and pick up policy:

Camp gates/ classroom doors do not open until your program starts at 9:30am. Please understand and respect that the time before the gates open is our teacher preparation time. If you arrive early you may wait at the gate until the teachers open it. If you proceed thru the gate and drop your camper off before your session starts a fee of $20 will be charged and expected at the time you drop off your child, unless you have made prior arrangements by email for before and after care.

Summer Programs: Camp ends at 2:30pm For Animal Adventures, 2pm for Wacky Wranglers and 11:30 for Pony Pals. Wacky Wranglers and Pony Pals are suspended for the summer of 2023. We hope to be able to bring those programs back in the future. Repeated tardiness to pick up your child will result in a $20 charge each day you are late. We understand the challenges of traffic and do our best to be accommodating and understand when this occurs occasionally. The charge is meant to detour tardiness on a daily basis as this is hard on our teachers if they need to go to an appointment or have other plans after work.

We ask that you respect our teacher’s personal time as well and also understand that like many of you she may be traveling to a from Anchorage. There may be days that she has scheduled a dentist, doctor eye or other appointment and she may need to leave promptly at the end of your session. Please understand that our desire for you to pick your child up on time is not meant cause you any hardship. We generally understand a few minutes here and there. If you are repeatedly late and by more than a few minutes you will be asked to pay a $20 late pick up fee.

If you need before and after care please make these arrangements by talking to the teacher directly. Alaska State Minimum Wage is $10.34 pr hour. We pay our fill in help $15 per hour. Due to the cost of teachers pay before and after care is generally not provided by our certified teachers but our qualified teaching assistant or other staff. In the event that you need before and after care and your child is the only child that needs this you will be expected to pay the hourly wage of $15 per hour that your child requires care for up to 1 hour before camp starts and for 1 hour after camp ends, This can be arranged by speaking directly with us by phone, text or email.. If 6 kids or more are in need of before and after care the cost will be $20 for the full week for before care and $20 for the full week for after care or $35 for the full week for both.

*Liability Release 

I understand that the program takes place in farm setting with exposure to animals, plants, and agricultural products. Students attending an animal related program will take part in both horse and other animal related activities. I understand and acknowledge that the activity of horsemanship, both horse riding and cart driving involves some risk, that an animal irrespective of its training and usual past behavior and characteristic may act or react unexpectedly or unpredictably at times and as such I assume such risks. I understand Students may take part in daily farm activities which may be potentially hazardous activities, including but not limited to, grooming animals, horse riding, leading animals, and feeding animals.  I also understand that regardless of my child’s past allergy or non-allergy status, exposure to animals and their by products such as but not limited to wool, milk and manure can result in an allergic reaction. Recognizing the potential hazards outlined above, I on behalf of myself, my child and my assigns, do hereby release Follow the Child, Party Ponies and Friends, its employees, agents, successors, and assigns, of and from any and all liability, causes of action, claims and demands of every kind and nature whatsoever arising out of my child’s participation in any Party Ponies and Friends, and or "Follow the Child "Camp, including but not limited to any claim arising out of the conditions of the premises, the operations of the camp, the acts or omissions of Party Ponies and friends, and "Follow the Child" employees and agents, or any other negligence. I further agree to indemnify and hold harmless "Follow the Child", Party Ponies and Friends , and its employees and agents, for and from any damages, including reasonable attorneys’ fees and costs, incurred in connection with my child’s participation in camp. If my child has a known allergy that requires the use of an epipen I on behalf of myself, my child and my assigns, do hereby release Follow the Child, Party Ponies and Friends, its employees, agents, successors, and assigns, of and from any and all liability, for injury arising from the self-administration or storage of the medication; I further agree to indemnify and hold harmless "Follow the Child", Party Ponies and Friends , and its employees and agents, for and from any damages, including reasonable attorneys’ fees and costs, incurred in connection with my child’s use of the epipen/inhaler and or storage of the medication.

Personal Responsibility related to Novel Corona Virus/ Covid 19:

Novel Corona Virus/covid 19 has been declared a world wide pandemic by the World Health Organization.COVID19 is reported to be extremely contagious .The state of medical knowledge is evolving, but the virus is believed to spread from person to person contact and/or by contact with contaminated surfaces, objects or possibly in the air. People reportedly can be infected and show no symptoms and therefor spread the disease.The exact method of spread and contraction are currently unknown and there is no known treatment or cure.. Evidence has shown that covid 19 can cause serious and potentially life threatening illness and even death.

Party Ponies and Friends/Follow the Child on the Farm cannot prevent you or your child(ren) from becoming exposed to, contracting, or spreading covid-19 while utilizing our premises. It's not possible to prevent against the presence of the disease. Therefor, if you choose to utilize our services and/or enter onto Party Ponies and Friends/ Follow the Child premises you may be exposing yourself to and /or increasing your risk of contracting or spreading covid-19. Our programs are outdoors when possible which has been said to provide less risk of exposure.

Assumption of Risk: I have read and understand the above warning concerning covid-19. I hereby choose to accept the risk of contracting covid 19 for myself and/or my children in order to utilize Party Ponies and Friends /Follow the Childs services.

Covid 19 Waiver of Lawsuit/Liability: Recognizing the potential hazards outlined above regarding the Novel Corona Virus/Covid 19, I on behalf of myself, my child and my assigns, do hereby release Follow the Child, Party Ponies and Friends, its employees, agents, successors, and assigns, of and from any and all liability, causes of action, claims and demands of every kind and nature whatsoever arising out of my child’s participation in any Party Ponies and Friends, and or "Follow the Child " programs, including but not limited to any claim arising out of the conditions of the premises, the operations of the camp, the acts or omissions of Party Ponies and friends, and "Follow the Child" employees and agents, or any other negligence. I further agree to indemnify and hold harmless "Follow the Child", Party Ponies and Friends , and its employees and agents, for and from any damages, including reasonable attorneys’ fees and costs, incurred in connection with my child’s participation in camp.

I/we hereby allow, Follow the Child and Party Ponies and Friends to use photographs, audio clips or video images of my child for promotional materials.

I/we have read and agree to the terms and policies in this application, liability release form and the camp literature.

I/we have read and understand your payment policy

*Permission to Treat

I attest that my child is in good health and able to actively participate in program activities except as noted by my personal email to educators sent prior to my child's first session date outlining any limitations they have. I take full responsibility to see that my child is properly prepared for camp including having proper clothes and equipment and being in good health.

I authorize the program to provide routine health care,such as washing out a cut and various camp related bumps and bruises, administer over-the-counter medications for various problems.such as neosporin and the use of band aids.


I authorize the camp to share information in this Health Form with selected camp staff (counselor, health care & inclusion staff) and professional health care providers on a need-to-know basis.

In the event I cannot be reached in an emergency, I hereby give permission to the medical personnel selected by the camp director to order x-rays, routine tests, treatments; to release any records necessary for insurance purposes; to provide/arrange necessary transportation for my child.

I give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, for my child.







 

 

 








EQUINE RIDING and / or DRIVING and / or TRAINING INSTRUCTION AGREEMENT, LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT NAHA

READ CAREFULLY AND COMPLETE ALL SECTIONS BEFORE SIGNING.

A.     REGISTRATION OF STUDENT AND AGREEMENT PURPOSEI, the following listed individual, and the parents or legal guardians thereof if a minor, do hereby voluntarily agree to participate in equine related instruction as a student of THIS STABLE, and that I will either utilize my own horse or school horses provided by THIS STABLE for instruction purposes.

B. AGREEMENT SCOPE AND TERRITORY AND DEFINITIONS This agreement shall be legally binding upon me the registered student, and the parents or legal guardians thereof if a minor, my heirs, estate, assigns, including all minor children, and personal representatives; and it shall be interpreted according to the laws of the state and county of THIS STABLE'S physical location. This agreement is intended to be valid and binding at all times now and in the future when THIS STABLE permits me (directly or indirectly) to enter THIS STABLE’S property, be on THIS STABLE’S property, be near any horse, receive riding and / or driving and / or training instruction or guidance from its associates and / or when I ride and / or drive and / or train and / or am near horses on or off of THIS STABLE’S property. Any disputes by the rider shall be litigated in, and venue shall be the county in which THIS STABLE is physically located. This agreement is intended to be as broad and inclusive as the law permits. If any clause, phrase, or word is in conflict with state law, then that single part is null and void. The terms "HORSE" and “EQUINE” herein shall refer to all equine species. The terms "I", “WE”, "ME", "MY" shall herein refer to the above registered student and the parents or legal guardians thereof if a minor.

C. INHERENT RISKS / ASSUMPTION OF RISKS I / WE ACKNOWLEDGE THAT: Risks, conditions, and dangers are inherent in (meaning an integral part of) horse / equine / animal activities, regardless of all feasible safety measures which can be taken, and I agree to assume them. The inherent risks include, but are not limited to any of the following: The propensity of an animal to behave in ways that may result in injury, harm, death, or loss to persons on or around the animal; The unpredictability of an equine’s reaction to sounds, sudden movement, unfamiliar objects, persons, or other animals; Hazards, including, but not limited to, surface or subsurface conditions; A collision, encounter and / or confrontation with another equine, another animal, a person, or an object; The potential of an equine activity participant to act in a negligent manner that may contribute to injury, harm, death, or loss to the participant or to other persons, including but not limited to, failing to maintain control over an equine and / or failing to act within the ability of the participant. Horses are 5 to 15 times larger, 20 to 40 times more powerful, and 3 to 4 times faster than a human. If a rider falls from horse to ground it will generally be at a distance of from 3 1/2 to 5 1/2 feet, and the impact may result in harm to the rider. Horseback riding, driving and training are activities in which one much smaller, weaker predator animal (the human) tries to impose its will on, and become one unit of movement with, another much larger, stronger prey animal that has a mind of its own (the horse) and each has a limited understanding of the other. If a horse is frightened or provoked it may divert from its training and act according to its natural survival instincts which may include, but are not limited to: Stopping short; Spinning around; Changing directions and / or speed at will; Shifting its weight; Bucking; Rearing; Kicking; Biting; and / or Running from danger. I also acknowledge that these are just some of the risks and I agree to assume others not mentioned above. I am not relying on THIS STABLE to list all possible risks for me

D. CONDITIONS OF NATURE WARNING, UNFAMILIAR AND SUDDEN SIGHTS, SOUNDS AND MOVEMENTS WARNING, AND INSPECTION OF PREMISES I / WE ACKNOWLEDGE THAT: THIS STABLE is NOT responsible for total or partial acts, occurrences, or elements of nature and / or sudden and / or unfamiliar sights, sounds and / or sudden movements that can scare a horse, cause it to fall, or react in some other unsafe way. SOME EXAMPLES ARE: Thunder, lightening, rain, wind, wild and domestic animals, insects, reptiles, which may walk, run, or fly near, or bite or sting a horse or person; and irregular footing on out-of-door groomed or wild land which is subject to constant change in condition according to weather, temperature, and natural and man-made changes in landscape. I also understand that these are just some of the risks and I agree to assume others not mentioned above. I am not relying on THIS STABLE to list all possible conditions for me. The student and parent or legal guardian have inspected THIS STABLE'S facilities and are satisfied that all premise conditions are reasonably safe for this student’s intended purpose, usage and presence upon THIS STABLE'S premises.

E. SADDLE GIRTHS / NATURAL LOOSENING WARNING I / WE ACKNOWLEDGE THAT: Saddle girths (fastener straps around horse's belly) may loosen during riding. Students must alert the instructor or attendant of any girth looseness so action can be taken to avoid slippage of saddle and the potential for the rider to fall from the horse.

F. PROTECTIVE HEADGEAR / HELMET WARNING I / WE AGREE THAT: I for myself and on behalf of my child and / or legal ward have been fully warned and advised by THIS STABLE that protective headgear / helmet, which meets or exceeds the quality standards of the SEI CERTIFIED ASTM STANDARD F 1163 Equestrian Helmet, should be worn while riding and / or driving and / or training and / or being near horses, and I understand that the wearing of such headgear / helmet at these times may reduce severity of some of the wearer's head injuries and possibly prevent the wearer's death from happening as the result of a fall and other occurrences. I am not relying on THIS STABLE and / or its associates to provide a certified helmet for me or to check any headgear / helmet or headgear / helmet strap that I may wear, or to monitor my compliance with this suggestion at any time now or in the future.

G. LIABILITY RELEASE I / WE AGREE THAT: In consideration of THIS STABLE allowing my participation in this activity, under the terms set forth herein, I, the STUDENT, for myself and on behalf of my child and / or legal ward, heirs, administrators, personal representatives or assigns, do agree to release, hold harmless, and discharge THIS STABLE, its owners, agents, employees, officers, directors, representatives, assigns, members, owners of premises and trails, affiliated organizations, and Insurers, and others acting on their behalf (hereinafter, collectively referred to as "Associates"), of and from all claims, demands, causes of action and legal liability, whether the same be known or unknown, anticipated or unanticipated, due to THIS STABLE'S and / or ITS ASSOCIATE’S ordinary negligence or legal liability; and I do further agree that except in the event of THIS STABLE'S gross negligence and / or willful and / or wanton misconduct, I shall not bring any claims, demands, legal actions and causes of action, against THIS STABLE and ITS ASSOCIATES as stated above in this clause, for any economic and non-economic losses due to bodily injury and / or death and / or property damage, sustained by me and / or my minor child or legal ward in relation to the premises and operations of THIS STABLE, to include while riding, driving, training, handling, or otherwise being near horses owned by me or owned by THIS STABLE, or in the care, custody or control of THIS STABLE, whether on or off the premises of THIS STABLE, but not limited to being on THIS STABLE’S premises.

All Students and Parents or Legal Guardians must sign below after reading this entire document.

SIGNER STATEMENT OF AWARENESS

I / WE, THE UNDERSIGNED, REPRESENT THAT I / WE HAVE READ AND DO UNDERSTAND THE FOREGOING AGREEMENT, LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT, I / WE UNDERSTAND THAT BY SIGNING THIS DOCUMENT I AM GIVING UP RIGHTS TO SUE TODAY AND IN THE FUTURE. I / WE ATTEST THAT ALL FACTS ARE TRUE AND ACCURATE. I AM SIGNING THIS WHILE OF SOUND MIND AND NOT SUFFERING FROM SHOCK, OR UNDER THE INFLUENCE OF ALCOHOL, DRUGS OR INTOXICANTS.



First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Age *
Weight over 240?*
No
Yes
Horse Handling/Riding Experience Check one that applies *
Beginner (under 10 hours)
Over 10 hours
Does this student have any physical or mental condition(s) which may affect his/her safety and ability to ride ,drive and / or train a horse?*
No
Yes

If you answered "YES" to the above question how can we help this student with his/her special needs?

MEDICAL INSURANCE I/WE AGREE THAT: Should medical treatment be required, I and/or my medical insurance company shall pay for all such incurred expenses. My medical insurance company is. My Policy number is

Please provide the date your child/children will be attending *

Please Provide the Name of the Friend or sibling if using the Bring a Friend special for July 8-12. If not using this sale type NA *
Will you be using a Direct Pay Agreement from any of the following schools IDEA, Totem, cyberlinx*
No
Yes
Does your child have any medical, physical, intellectual or emotional conditions that may affect their ability to meet the above necessities and partake safely in Party Ponies physically active Farm Life Camp?*
No
Yes

If yes please briefly describe. Having different abilities will not exclude your child from camp. Being aware of your child's needs will give our educators the ability to help your child participate in camp activities appropriately.
Is your child allergic to milk?*
No
Yes
Is your child allergic to eggs?*
No
Yes
Is your child allergic to wool?*
No
Yes
Does your child have any other allergies that we should be aware of?*
No
Yes

If yes please describe your child's allergy
If any of the allergy questions above were answered yes I understand that I have previously initialed and signed a hold harmless release related to my child's allergy and it is my responsibility to administer my child the necessary medication prior the camp day for them to be comfortable around animals and these lessons. Party Ponies and Friends and Follow the Child on the Farm does not administer medication. If you answer no to this question your child will not be allowed at camp. All payment rules will still apply. Your deposit will be returned to you when your child's camp spot is filled by another student.*
No
Yes
Does your child's allergy require an epipen?*
No
Yes
If your child's allergy requires an epipen then you have already signed the written authorization for personal use and the release of liability related to the personal use and storage of this epipen during the camp program. Do you agree to provide the following per state requirements prior to the first day of camp?(2) written certification from the pupil's health care provider that the pupil (A) has asthma or a condition that may lead to anaphylaxis; (B) has received instruction in the proper method of self-administration of the medication; and (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;(5) a written treatment plan for the pupil that is signed by the pupil's health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; if you answer no to this question your child will not be permitted at camp. Your deposit will be refunded if your child's spot at camp is filled by another student*
No
Yes

Please provide the name of the person that will be paying for your child's participation so that we can match this document with that payment. *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Age *
Weight over 240?*
No
Yes
Horse Handling/Riding Experience Check one that applies *
Beginner (under 10 hours)
Over 10 hours
Does this student have any physical or mental condition(s) which may affect his/her safety and ability to ride ,drive and / or train a horse?*
No
Yes

If you answered "YES" to the above question how can we help this student with his/her special needs?

MEDICAL INSURANCE I/WE AGREE THAT: Should medical treatment be required, I and/or my medical insurance company shall pay for all such incurred expenses. My medical insurance company is. My Policy number is

Please provide the date your child/children will be attending *

Please Provide the Name of the Friend or sibling if using the Bring a Friend special for July 8-12. If not using this sale type NA *
Will you be using a Direct Pay Agreement from any of the following schools IDEA, Totem, cyberlinx*
No
Yes
Does your child have any medical, physical, intellectual or emotional conditions that may affect their ability to meet the above necessities and partake safely in Party Ponies physically active Farm Life Camp?*
No
Yes

If yes please briefly describe. Having different abilities will not exclude your child from camp. Being aware of your child's needs will give our educators the ability to help your child participate in camp activities appropriately.
Is your child allergic to milk?*
No
Yes
Is your child allergic to eggs?*
No
Yes
Is your child allergic to wool?*
No
Yes
Does your child have any other allergies that we should be aware of?*
No
Yes

If yes please describe your child's allergy
If any of the allergy questions above were answered yes I understand that I have previously initialed and signed a hold harmless release related to my child's allergy and it is my responsibility to administer my child the necessary medication prior the camp day for them to be comfortable around animals and these lessons. Party Ponies and Friends and Follow the Child on the Farm does not administer medication. If you answer no to this question your child will not be allowed at camp. All payment rules will still apply. Your deposit will be returned to you when your child's camp spot is filled by another student.*
No
Yes
Does your child's allergy require an epipen?*
No
Yes
If your child's allergy requires an epipen then you have already signed the written authorization for personal use and the release of liability related to the personal use and storage of this epipen during the camp program. Do you agree to provide the following per state requirements prior to the first day of camp?(2) written certification from the pupil's health care provider that the pupil (A) has asthma or a condition that may lead to anaphylaxis; (B) has received instruction in the proper method of self-administration of the medication; and (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;(5) a written treatment plan for the pupil that is signed by the pupil's health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; if you answer no to this question your child will not be permitted at camp. Your deposit will be refunded if your child's spot at camp is filled by another student*
No
Yes

Please provide the name of the person that will be paying for your child's participation so that we can match this document with that payment. *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Age *
Weight over 240?*
No
Yes
Horse Handling/Riding Experience Check one that applies *
Beginner (under 10 hours)
Over 10 hours
Does this student have any physical or mental condition(s) which may affect his/her safety and ability to ride ,drive and / or train a horse?*
No
Yes

If you answered "YES" to the above question how can we help this student with his/her special needs?

MEDICAL INSURANCE I/WE AGREE THAT: Should medical treatment be required, I and/or my medical insurance company shall pay for all such incurred expenses. My medical insurance company is. My Policy number is

Please provide the date your child/children will be attending *

Please Provide the Name of the Friend or sibling if using the Bring a Friend special for July 8-12. If not using this sale type NA *
Will you be using a Direct Pay Agreement from any of the following schools IDEA, Totem, cyberlinx*
No
Yes
Does your child have any medical, physical, intellectual or emotional conditions that may affect their ability to meet the above necessities and partake safely in Party Ponies physically active Farm Life Camp?*
No
Yes

If yes please briefly describe. Having different abilities will not exclude your child from camp. Being aware of your child's needs will give our educators the ability to help your child participate in camp activities appropriately.
Is your child allergic to milk?*
No
Yes
Is your child allergic to eggs?*
No
Yes
Is your child allergic to wool?*
No
Yes
Does your child have any other allergies that we should be aware of?*
No
Yes

If yes please describe your child's allergy
If any of the allergy questions above were answered yes I understand that I have previously initialed and signed a hold harmless release related to my child's allergy and it is my responsibility to administer my child the necessary medication prior the camp day for them to be comfortable around animals and these lessons. Party Ponies and Friends and Follow the Child on the Farm does not administer medication. If you answer no to this question your child will not be allowed at camp. All payment rules will still apply. Your deposit will be returned to you when your child's camp spot is filled by another student.*
No
Yes
Does your child's allergy require an epipen?*
No
Yes
If your child's allergy requires an epipen then you have already signed the written authorization for personal use and the release of liability related to the personal use and storage of this epipen during the camp program. Do you agree to provide the following per state requirements prior to the first day of camp?(2) written certification from the pupil's health care provider that the pupil (A) has asthma or a condition that may lead to anaphylaxis; (B) has received instruction in the proper method of self-administration of the medication; and (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;(5) a written treatment plan for the pupil that is signed by the pupil's health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; if you answer no to this question your child will not be permitted at camp. Your deposit will be refunded if your child's spot at camp is filled by another student*
No
Yes

Please provide the name of the person that will be paying for your child's participation so that we can match this document with that payment. *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Age *
Weight over 240?*
No
Yes
Horse Handling/Riding Experience Check one that applies *
Beginner (under 10 hours)
Over 10 hours
Does this student have any physical or mental condition(s) which may affect his/her safety and ability to ride ,drive and / or train a horse?*
No
Yes

If you answered "YES" to the above question how can we help this student with his/her special needs?

MEDICAL INSURANCE I/WE AGREE THAT: Should medical treatment be required, I and/or my medical insurance company shall pay for all such incurred expenses. My medical insurance company is. My Policy number is

Please provide the date your child/children will be attending *

Please Provide the Name of the Friend or sibling if using the Bring a Friend special for July 8-12. If not using this sale type NA *
Will you be using a Direct Pay Agreement from any of the following schools IDEA, Totem, cyberlinx*
No
Yes
Does your child have any medical, physical, intellectual or emotional conditions that may affect their ability to meet the above necessities and partake safely in Party Ponies physically active Farm Life Camp?*
No
Yes

If yes please briefly describe. Having different abilities will not exclude your child from camp. Being aware of your child's needs will give our educators the ability to help your child participate in camp activities appropriately.
Is your child allergic to milk?*
No
Yes
Is your child allergic to eggs?*
No
Yes
Is your child allergic to wool?*
No
Yes
Does your child have any other allergies that we should be aware of?*
No
Yes

If yes please describe your child's allergy
If any of the allergy questions above were answered yes I understand that I have previously initialed and signed a hold harmless release related to my child's allergy and it is my responsibility to administer my child the necessary medication prior the camp day for them to be comfortable around animals and these lessons. Party Ponies and Friends and Follow the Child on the Farm does not administer medication. If you answer no to this question your child will not be allowed at camp. All payment rules will still apply. Your deposit will be returned to you when your child's camp spot is filled by another student.*
No
Yes
Does your child's allergy require an epipen?*
No
Yes
If your child's allergy requires an epipen then you have already signed the written authorization for personal use and the release of liability related to the personal use and storage of this epipen during the camp program. Do you agree to provide the following per state requirements prior to the first day of camp?(2) written certification from the pupil's health care provider that the pupil (A) has asthma or a condition that may lead to anaphylaxis; (B) has received instruction in the proper method of self-administration of the medication; and (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;(5) a written treatment plan for the pupil that is signed by the pupil's health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; if you answer no to this question your child will not be permitted at camp. Your deposit will be refunded if your child's spot at camp is filled by another student*
No
Yes

Please provide the name of the person that will be paying for your child's participation so that we can match this document with that payment. *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Age *
Weight over 240?*
No
Yes
Horse Handling/Riding Experience Check one that applies *
Beginner (under 10 hours)
Over 10 hours
Does this student have any physical or mental condition(s) which may affect his/her safety and ability to ride ,drive and / or train a horse?*
No
Yes

If you answered "YES" to the above question how can we help this student with his/her special needs?

MEDICAL INSURANCE I/WE AGREE THAT: Should medical treatment be required, I and/or my medical insurance company shall pay for all such incurred expenses. My medical insurance company is. My Policy number is

Please provide the date your child/children will be attending *

Please Provide the Name of the Friend or sibling if using the Bring a Friend special for July 8-12. If not using this sale type NA *
Will you be using a Direct Pay Agreement from any of the following schools IDEA, Totem, cyberlinx*
No
Yes
Does your child have any medical, physical, intellectual or emotional conditions that may affect their ability to meet the above necessities and partake safely in Party Ponies physically active Farm Life Camp?*
No
Yes

If yes please briefly describe. Having different abilities will not exclude your child from camp. Being aware of your child's needs will give our educators the ability to help your child participate in camp activities appropriately.
Is your child allergic to milk?*
No
Yes
Is your child allergic to eggs?*
No
Yes
Is your child allergic to wool?*
No
Yes
Does your child have any other allergies that we should be aware of?*
No
Yes

If yes please describe your child's allergy
If any of the allergy questions above were answered yes I understand that I have previously initialed and signed a hold harmless release related to my child's allergy and it is my responsibility to administer my child the necessary medication prior the camp day for them to be comfortable around animals and these lessons. Party Ponies and Friends and Follow the Child on the Farm does not administer medication. If you answer no to this question your child will not be allowed at camp. All payment rules will still apply. Your deposit will be returned to you when your child's camp spot is filled by another student.*
No
Yes
Does your child's allergy require an epipen?*
No
Yes
If your child's allergy requires an epipen then you have already signed the written authorization for personal use and the release of liability related to the personal use and storage of this epipen during the camp program. Do you agree to provide the following per state requirements prior to the first day of camp?(2) written certification from the pupil's health care provider that the pupil (A) has asthma or a condition that may lead to anaphylaxis; (B) has received instruction in the proper method of self-administration of the medication; and (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;(5) a written treatment plan for the pupil that is signed by the pupil's health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; if you answer no to this question your child will not be permitted at camp. Your deposit will be refunded if your child's spot at camp is filled by another student*
No
Yes

Please provide the name of the person that will be paying for your child's participation so that we can match this document with that payment. *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Age *
Weight over 240?*
No
Yes
Horse Handling/Riding Experience Check one that applies *
Beginner (under 10 hours)
Over 10 hours
Does this student have any physical or mental condition(s) which may affect his/her safety and ability to ride ,drive and / or train a horse?*
No
Yes

If you answered "YES" to the above question how can we help this student with his/her special needs?

MEDICAL INSURANCE I/WE AGREE THAT: Should medical treatment be required, I and/or my medical insurance company shall pay for all such incurred expenses. My medical insurance company is. My Policy number is

Please provide the date your child/children will be attending *

Please Provide the Name of the Friend or sibling if using the Bring a Friend special for July 8-12. If not using this sale type NA *
Will you be using a Direct Pay Agreement from any of the following schools IDEA, Totem, cyberlinx*
No
Yes
Does your child have any medical, physical, intellectual or emotional conditions that may affect their ability to meet the above necessities and partake safely in Party Ponies physically active Farm Life Camp?*
No
Yes

If yes please briefly describe. Having different abilities will not exclude your child from camp. Being aware of your child's needs will give our educators the ability to help your child participate in camp activities appropriately.
Is your child allergic to milk?*
No
Yes
Is your child allergic to eggs?*
No
Yes
Is your child allergic to wool?*
No
Yes
Does your child have any other allergies that we should be aware of?*
No
Yes

If yes please describe your child's allergy
If any of the allergy questions above were answered yes I understand that I have previously initialed and signed a hold harmless release related to my child's allergy and it is my responsibility to administer my child the necessary medication prior the camp day for them to be comfortable around animals and these lessons. Party Ponies and Friends and Follow the Child on the Farm does not administer medication. If you answer no to this question your child will not be allowed at camp. All payment rules will still apply. Your deposit will be returned to you when your child's camp spot is filled by another student.*
No
Yes
Does your child's allergy require an epipen?*
No
Yes
If your child's allergy requires an epipen then you have already signed the written authorization for personal use and the release of liability related to the personal use and storage of this epipen during the camp program. Do you agree to provide the following per state requirements prior to the first day of camp?(2) written certification from the pupil's health care provider that the pupil (A) has asthma or a condition that may lead to anaphylaxis; (B) has received instruction in the proper method of self-administration of the medication; and (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;(5) a written treatment plan for the pupil that is signed by the pupil's health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; if you answer no to this question your child will not be permitted at camp. Your deposit will be refunded if your child's spot at camp is filled by another student*
No
Yes

Please provide the name of the person that will be paying for your child's participation so that we can match this document with that payment. *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Age *
Weight over 240?*
No
Yes
Horse Handling/Riding Experience Check one that applies *
Beginner (under 10 hours)
Over 10 hours
Does this student have any physical or mental condition(s) which may affect his/her safety and ability to ride ,drive and / or train a horse?*
No
Yes

If you answered "YES" to the above question how can we help this student with his/her special needs?

MEDICAL INSURANCE I/WE AGREE THAT: Should medical treatment be required, I and/or my medical insurance company shall pay for all such incurred expenses. My medical insurance company is. My Policy number is

Please provide the date your child/children will be attending *

Please Provide the Name of the Friend or sibling if using the Bring a Friend special for July 8-12. If not using this sale type NA *
Will you be using a Direct Pay Agreement from any of the following schools IDEA, Totem, cyberlinx*
No
Yes
Does your child have any medical, physical, intellectual or emotional conditions that may affect their ability to meet the above necessities and partake safely in Party Ponies physically active Farm Life Camp?*
No
Yes

If yes please briefly describe. Having different abilities will not exclude your child from camp. Being aware of your child's needs will give our educators the ability to help your child participate in camp activities appropriately.
Is your child allergic to milk?*
No
Yes
Is your child allergic to eggs?*
No
Yes
Is your child allergic to wool?*
No
Yes
Does your child have any other allergies that we should be aware of?*
No
Yes

If yes please describe your child's allergy
If any of the allergy questions above were answered yes I understand that I have previously initialed and signed a hold harmless release related to my child's allergy and it is my responsibility to administer my child the necessary medication prior the camp day for them to be comfortable around animals and these lessons. Party Ponies and Friends and Follow the Child on the Farm does not administer medication. If you answer no to this question your child will not be allowed at camp. All payment rules will still apply. Your deposit will be returned to you when your child's camp spot is filled by another student.*
No
Yes
Does your child's allergy require an epipen?*
No
Yes
If your child's allergy requires an epipen then you have already signed the written authorization for personal use and the release of liability related to the personal use and storage of this epipen during the camp program. Do you agree to provide the following per state requirements prior to the first day of camp?(2) written certification from the pupil's health care provider that the pupil (A) has asthma or a condition that may lead to anaphylaxis; (B) has received instruction in the proper method of self-administration of the medication; and (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;(5) a written treatment plan for the pupil that is signed by the pupil's health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; if you answer no to this question your child will not be permitted at camp. Your deposit will be refunded if your child's spot at camp is filled by another student*
No
Yes

Please provide the name of the person that will be paying for your child's participation so that we can match this document with that payment. *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Age *
Weight over 240?*
No
Yes
Horse Handling/Riding Experience Check one that applies *
Beginner (under 10 hours)
Over 10 hours
Does this student have any physical or mental condition(s) which may affect his/her safety and ability to ride ,drive and / or train a horse?*
No
Yes

If you answered "YES" to the above question how can we help this student with his/her special needs?

MEDICAL INSURANCE I/WE AGREE THAT: Should medical treatment be required, I and/or my medical insurance company shall pay for all such incurred expenses. My medical insurance company is. My Policy number is

Please provide the date your child/children will be attending *

Please Provide the Name of the Friend or sibling if using the Bring a Friend special for July 8-12. If not using this sale type NA *
Will you be using a Direct Pay Agreement from any of the following schools IDEA, Totem, cyberlinx*
No
Yes
Does your child have any medical, physical, intellectual or emotional conditions that may affect their ability to meet the above necessities and partake safely in Party Ponies physically active Farm Life Camp?*
No
Yes

If yes please briefly describe. Having different abilities will not exclude your child from camp. Being aware of your child's needs will give our educators the ability to help your child participate in camp activities appropriately.
Is your child allergic to milk?*
No
Yes
Is your child allergic to eggs?*
No
Yes
Is your child allergic to wool?*
No
Yes
Does your child have any other allergies that we should be aware of?*
No
Yes

If yes please describe your child's allergy
If any of the allergy questions above were answered yes I understand that I have previously initialed and signed a hold harmless release related to my child's allergy and it is my responsibility to administer my child the necessary medication prior the camp day for them to be comfortable around animals and these lessons. Party Ponies and Friends and Follow the Child on the Farm does not administer medication. If you answer no to this question your child will not be allowed at camp. All payment rules will still apply. Your deposit will be returned to you when your child's camp spot is filled by another student.*
No
Yes
Does your child's allergy require an epipen?*
No
Yes
If your child's allergy requires an epipen then you have already signed the written authorization for personal use and the release of liability related to the personal use and storage of this epipen during the camp program. Do you agree to provide the following per state requirements prior to the first day of camp?(2) written certification from the pupil's health care provider that the pupil (A) has asthma or a condition that may lead to anaphylaxis; (B) has received instruction in the proper method of self-administration of the medication; and (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;(5) a written treatment plan for the pupil that is signed by the pupil's health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; if you answer no to this question your child will not be permitted at camp. Your deposit will be refunded if your child's spot at camp is filled by another student*
No
Yes

Please provide the name of the person that will be paying for your child's participation so that we can match this document with that payment. *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Age *
Weight over 240?*
No
Yes
Horse Handling/Riding Experience Check one that applies *
Beginner (under 10 hours)
Over 10 hours
Does this student have any physical or mental condition(s) which may affect his/her safety and ability to ride ,drive and / or train a horse?*
No
Yes

If you answered "YES" to the above question how can we help this student with his/her special needs?

MEDICAL INSURANCE I/WE AGREE THAT: Should medical treatment be required, I and/or my medical insurance company shall pay for all such incurred expenses. My medical insurance company is. My Policy number is

Please provide the date your child/children will be attending *

Please Provide the Name of the Friend or sibling if using the Bring a Friend special for July 8-12. If not using this sale type NA *
Will you be using a Direct Pay Agreement from any of the following schools IDEA, Totem, cyberlinx*
No
Yes
Does your child have any medical, physical, intellectual or emotional conditions that may affect their ability to meet the above necessities and partake safely in Party Ponies physically active Farm Life Camp?*
No
Yes

If yes please briefly describe. Having different abilities will not exclude your child from camp. Being aware of your child's needs will give our educators the ability to help your child participate in camp activities appropriately.
Is your child allergic to milk?*
No
Yes
Is your child allergic to eggs?*
No
Yes
Is your child allergic to wool?*
No
Yes
Does your child have any other allergies that we should be aware of?*
No
Yes

If yes please describe your child's allergy
If any of the allergy questions above were answered yes I understand that I have previously initialed and signed a hold harmless release related to my child's allergy and it is my responsibility to administer my child the necessary medication prior the camp day for them to be comfortable around animals and these lessons. Party Ponies and Friends and Follow the Child on the Farm does not administer medication. If you answer no to this question your child will not be allowed at camp. All payment rules will still apply. Your deposit will be returned to you when your child's camp spot is filled by another student.*
No
Yes
Does your child's allergy require an epipen?*
No
Yes
If your child's allergy requires an epipen then you have already signed the written authorization for personal use and the release of liability related to the personal use and storage of this epipen during the camp program. Do you agree to provide the following per state requirements prior to the first day of camp?(2) written certification from the pupil's health care provider that the pupil (A) has asthma or a condition that may lead to anaphylaxis; (B) has received instruction in the proper method of self-administration of the medication; and (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;(5) a written treatment plan for the pupil that is signed by the pupil's health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; if you answer no to this question your child will not be permitted at camp. Your deposit will be refunded if your child's spot at camp is filled by another student*
No
Yes

Please provide the name of the person that will be paying for your child's participation so that we can match this document with that payment. *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Age *
Weight over 240?*
No
Yes
Horse Handling/Riding Experience Check one that applies *
Beginner (under 10 hours)
Over 10 hours
Does this student have any physical or mental condition(s) which may affect his/her safety and ability to ride ,drive and / or train a horse?*
No
Yes

If you answered "YES" to the above question how can we help this student with his/her special needs?

MEDICAL INSURANCE I/WE AGREE THAT: Should medical treatment be required, I and/or my medical insurance company shall pay for all such incurred expenses. My medical insurance company is. My Policy number is

Please provide the date your child/children will be attending *

Please Provide the Name of the Friend or sibling if using the Bring a Friend special for July 8-12. If not using this sale type NA *
Will you be using a Direct Pay Agreement from any of the following schools IDEA, Totem, cyberlinx*
No
Yes
Does your child have any medical, physical, intellectual or emotional conditions that may affect their ability to meet the above necessities and partake safely in Party Ponies physically active Farm Life Camp?*
No
Yes

If yes please briefly describe. Having different abilities will not exclude your child from camp. Being aware of your child's needs will give our educators the ability to help your child participate in camp activities appropriately.
Is your child allergic to milk?*
No
Yes
Is your child allergic to eggs?*
No
Yes
Is your child allergic to wool?*
No
Yes
Does your child have any other allergies that we should be aware of?*
No
Yes

If yes please describe your child's allergy
If any of the allergy questions above were answered yes I understand that I have previously initialed and signed a hold harmless release related to my child's allergy and it is my responsibility to administer my child the necessary medication prior the camp day for them to be comfortable around animals and these lessons. Party Ponies and Friends and Follow the Child on the Farm does not administer medication. If you answer no to this question your child will not be allowed at camp. All payment rules will still apply. Your deposit will be returned to you when your child's camp spot is filled by another student.*
No
Yes
Does your child's allergy require an epipen?*
No
Yes
If your child's allergy requires an epipen then you have already signed the written authorization for personal use and the release of liability related to the personal use and storage of this epipen during the camp program. Do you agree to provide the following per state requirements prior to the first day of camp?(2) written certification from the pupil's health care provider that the pupil (A) has asthma or a condition that may lead to anaphylaxis; (B) has received instruction in the proper method of self-administration of the medication; and (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;(5) a written treatment plan for the pupil that is signed by the pupil's health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; if you answer no to this question your child will not be permitted at camp. Your deposit will be refunded if your child's spot at camp is filled by another student*
No
Yes

Please provide the name of the person that will be paying for your child's participation so that we can match this document with that payment. *
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Insurance

Insurance Carrier*

Insurance Policy Number*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Emergency Contacts

If you have multiple emergency contacts please include them here.

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Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Age *
Weight over 240?*
No
Yes
Horse Handling/Riding Experience Check one that applies *
Beginner (under 10 hours)
Over 10 hours
Does this student have any physical or mental condition(s) which may affect his/her safety and ability to ride ,drive and / or train a horse?*
No
Yes

If you answered "YES" to the above question how can we help this student with his/her special needs?

MEDICAL INSURANCE I/WE AGREE THAT: Should medical treatment be required, I and/or my medical insurance company shall pay for all such incurred expenses. My medical insurance company is. My Policy number is

Please provide the date your child/children will be attending *

Please Provide the Name of the Friend or sibling if using the Bring a Friend special for July 8-12. If not using this sale type NA *
Will you be using a Direct Pay Agreement from any of the following schools IDEA, Totem, cyberlinx*
No
Yes
Does your child have any medical, physical, intellectual or emotional conditions that may affect their ability to meet the above necessities and partake safely in Party Ponies physically active Farm Life Camp?*
No
Yes

If yes please briefly describe. Having different abilities will not exclude your child from camp. Being aware of your child's needs will give our educators the ability to help your child participate in camp activities appropriately.
Is your child allergic to milk?*
No
Yes
Is your child allergic to eggs?*
No
Yes
Is your child allergic to wool?*
No
Yes
Does your child have any other allergies that we should be aware of?*
No
Yes

If yes please describe your child's allergy
If any of the allergy questions above were answered yes I understand that I have previously initialed and signed a hold harmless release related to my child's allergy and it is my responsibility to administer my child the necessary medication prior the camp day for them to be comfortable around animals and these lessons. Party Ponies and Friends and Follow the Child on the Farm does not administer medication. If you answer no to this question your child will not be allowed at camp. All payment rules will still apply. Your deposit will be returned to you when your child's camp spot is filled by another student.*
No
Yes
Does your child's allergy require an epipen?*
No
Yes
If your child's allergy requires an epipen then you have already signed the written authorization for personal use and the release of liability related to the personal use and storage of this epipen during the camp program. Do you agree to provide the following per state requirements prior to the first day of camp?(2) written certification from the pupil's health care provider that the pupil (A) has asthma or a condition that may lead to anaphylaxis; (B) has received instruction in the proper method of self-administration of the medication; and (C) has demonstrated to the health care provider the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;(5) a written treatment plan for the pupil that is signed by the pupil's health care provider for managing asthma or anaphylaxis episodes, a list and dosage of medications needed during school hours, and permission for and instruction on storage of the medication at school; if you answer no to this question your child will not be permitted at camp. Your deposit will be refunded if your child's spot at camp is filled by another student*
No
Yes

Please provide the name of the person that will be paying for your child's participation so that we can match this document with that payment. *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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