Wingswept Farm, LLC
1529 Keene South Elkhorn Rd.
Nicholasville, KY 40356


The undersigned person or parent/guardian agrees to assume all responsibility and risk from the use of riding horses while attending summer camp, receiving riding instruction, or during general practice at Wingswept Farm. Further you agree to hold Wingswept Farm’s teachers, trainers, instructors, staff and employees harmless from all damages, liability or injury to person or property arising from riding lessons, general practice, equipment and presence in the stable or on the grounds of Wingswept Farm. This release includes activities at remote locations (such as horse shows, field trips, trail rides etc.). The undersigned person or parent/guardian acknowledges that horse back riding and other associated activities are inherently dangerous. Although not likely, risk of injury or death is a possibility.

WARNING: Under Kentucky state law, a farm animal activity sponsor, farm animal professionals, or other person does not have the duty to eliminate all risks of injury when participating in farm animal activities. There are inherent risks of injury that you voluntarily accept if you participate in farm animal activities. Under the Kentucky Equine Activity Statute KRS 247.4027, an equine professional is not liable for an injury to or the death of a participant in an equine activity resulting from an inherent risk of the equine activity.

The undersigned person consents to the performance of any necessary medical treatment in the case of an injury. Such medical treatment includes, but is not limited to x-rays, physical exams, anesthetic, medical or surgical diagnosis or treatment and/or hospital services. This medical consent applies to any activity at Wingswept Farm or activities under the authority of Wingswept Farm at remote locations. The undersigned agrees to pay all fees for doctors, hospital, ambulances, and any other medical charges incurred.

Helmets are to be worn at all times when riding at Wingswept Farm or remote locations under the instruction of Wingswept Farm representatives. The undersigned acknowledges that any instance of riding without a helmet is at the choice of the rider or that rider’s parent/guardian if the rider is of minor age. The undersigned specifically releases Wingswept Farm and its teachers, instructors, trainers, staff and employees from any liability resulting from any injury or accident that might have been avoided through the use of a helmet.

June 9, 2023

First Participant's Name

First Name*

Last Name*

First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Parent or Guardian's Email Address


Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*

Insurance Carrier*

Insurance Policy Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Additional medical or special needs information.

Please provide any drug allergies, food allergies, or special needs we should know about.
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*

Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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