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Parent Guardian Agreement

Campers are expected to follow all camp rules and behave appropriately  as such refunds cannot be given if a camper is  asked to leave for infraction of a camp rule or disruptive behavior or if a child is voluntarily withdrawn.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 campers, 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 campers, my child and/or staff, my child may be asked to leave camp and the tuition will not be refunded.

Tuition is nonrefundable.  If in the event that your schedule changes we are more than happy to move your child to another available week that still has open spots. Unless otherwise stated for the specific summer you are registering for, we have approximately 13 weeks of summer camp with 26 different camp options.  By initialling you are stating that you have read our payment policy and understand it.  We do our very best to accomodate parents in varies situations and our payment policy is clearly displayed on our website.  Unfortunately we can not hold spots at camp for those that do not intend to come.  We are bound by capacity rules with the American Camp Assosication and therefor when we hold your spot at camp we are turning away another camper. 

*Allergy Information:

Though we are not a public school we follow safety quidelines for puplic education.  Your childs safety and well being is our highest priority while they are enjoying camp actvities 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 thier epipen 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 childs use of an epipen while at summer camp and agree to follow these requirements by signing the release of liabity below and providing the above documents to the summer camp prior to my childs first day

*Substitute Teacher Information:

We make every effort to ensure that your child will have the same camp teacher for the full week of camp.  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.

*Drop off and pick up policy:

Camp gates and camp do not open until 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 9:30 am a fee of $20 will be charged and expected at the time you drop off your child, unless you have made prior arrangments by email for before and after care.

Camp ends at 3:00pm For Animal Adventures, 2pm for Wacky Wranglers and 11:30 for Pony Pals.  We have mulitple programs going on daily, due to teacher student ratios and capacity requirements of each camp it is not possible for us to simply allow your child to join a different ongoing camp program, there for it is imparative that your child be picked up on time.  Repeated tardiness will result in a $20 charge each day you are late. We understand the challenges of traffic and do our best to be accommodating. We ask that you respect our teacher’s personal time as well and also understand that like many of you she travels 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 3pm.  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 this may become available but is not a gaurentee.  Alaska State Minimum Wage is $9.84 pr hour. We pay our fill in help $10 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 $10 per hour that your child requires care for up to 1 hour before camp starts and for 1 hour after camp ends. Arrangements can be made by email.   If 6 kids or more are in need of before and after care the cost will be $15 for the full week for before care and $15 for the full week for after care or $25 for the full week for both.

*Liability Release 

I understand that the camp takes place in farm setting with exposure to animals, plants, and agricultural products. Campers 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 Campers 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 and or storage of the medication.

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 camp activities except as noted by my personal email to educators sent prior to my childs first camp 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 camp to provide routine health care, administer prescribed and over-the-counter medications for various problems.
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.


 

 

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
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 week of camp 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
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 week of camp 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
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 week of camp 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
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 week of camp 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
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 week of camp 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
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 week of camp 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
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 week of camp 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
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 week of camp 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
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 week of camp 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
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 week of camp 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.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
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.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

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