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CAMP REGISTRATION

Under Florida law (Title XLV, Chapter 773), an equine activity sponsor or equine professional is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities.

I have read the above warning and acknowledge my understanding and agree to hold harmless, discharge, not sue, and release Old Wire Holdings, LLC (DBA: Old Wire Stables), Charles Bryan, or other persons associated with stable located at 160 SW Brahman Glen Ft. White, Florida 32038, from liability for any and all bodily injuries or damages that I may sustain when on or near Stable’s premises, whether riding, handling or near horses, or other farm animals, causes in whole or in part by the ordinary negligence of Stable, its agents, employees, and/or assistants. The term “damages” means medical expenses; expenses incurred because of bodily injury or property damages, and/or personal property damages. Further, I agree to release, discharge and hold harmless Old Wire Holdings, LLC (DBA: Old Wire Stables), Charles Bryan, or other persons living at or associated with stable located at 160 SW Brahman Glen Ft. White, Florida 32038 from all claims, demands, actions, omissions, rights of action, or causes of action (present or future), liabilities or obligations whether the same be known or unknown, anticipated or unanticipated, resulting from or arising out of my Injuries or damages that may be sustained, or property damage, except if the injury or damage was caused by Stable’s gross negligence or wanton and willful misconduct. I (Print) also agree to hold harmless and release Old Wire Stables, Charles Bryan, or other persons living at 160 SW Brahman Glen Ft. White, Florida 32038 or associated with stable for any loss thereof, damage to, or theft of my equipment or personal belongings while at the Stable’s facility. ACTIVITY RISK CLASSIFICATIONS: I understand horseback riding is classified as a rugged adventure recreational activity, and that there are numerous obvious and non-obvious inherent risks always present in such activity despite all safety precautions. According to NEISS (National Electronic Injury Surveillance Systems of United States Consumer Products) horse activities rank 64th among the activities of people relative to injuries that result in a stay at U.S. hospitals. Related injuries can be severe requiring more hospital days and resulting in more lasting residual effects than injuries on other activities. I/WE further understand that applicant/s may have mounted or ground lessons that may encounter one or more of the following but not limited to: woods, rough terrain, hills, water, jumps, traffic, wild animals, and other horses.

I Agree


NATURE OF STABLE HORSES: I understand the instructor follows a rigid safety program. Yet, no horse is a completely safe horse. Horses are 5 to10 times larger, 20 to 40 times more powerful, and 3 to 4 times faster than a human. If a rider falls from a horse to the ground, it will generally be at a distance of from 3.5 to 5.5 feet, and the impact may result in injury to the rider. Horseback riding is the only sport where a much smaller, weaker predator animal (human) tries to impose its will on another much larger, stronger prey animal with a mind of its own and each has a limited understanding of each 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; changing directions or speed at will; shifting its weight; rearing; bucking: kicking; biting; or running from danger.

I Agree



First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Signature*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Signature*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Additional Information
Participant has Allergies?*
No
Yes

List any allergies (ex: bees,peanuts, dairy)

Any physical, mental or other condition that would require special attention or medication while at camp?
Participant takes medication Instructors need to b aware of?*
No
Yes

List all medications, both prescribed and over the counter, all medications will be turned into the health officer except rescue inhalers, bring all medication in original containers.

Explain medication instructions unless N/A
Participant knows how to swim?*
No
Yes
Participant has permission to swim in a pool or springs?*
No
Yes
Participant is permitted to travel to Ichetucknee Springs for a swimming excursion Friday?*
No
Yes
Participant may be photographed for social media or our website?*
No
Yes

Any activity the camper should be restricted from?
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
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(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*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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