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Wings of Hope Ranch

Rancher Application & Waiver

Please ensure that all of the following documents have been filled out and received on or before your child’s first session at the ranch. If you have any questions, please call

804-397-0469 or email us at Wingsofhoperanchercoordinator@outlook.com

Wings of Hope Ranch Client “Rancher” Application

Thank you for your interest in Wings of Hope Ranch, where children facing conflicts or challenges come together with rescued horses to help each other learn how to love and trust again.

OUR CORE FOCUS:  To share the love of Jesus through rescued horses to children ages 5 – 18

We look forward to the possibility of meeting you and ministering to your child.  Please complete the following application for your child(ren) who would like to participate in our program (please complete one application per child if more than one child will be participating).

Session Times:  ​Sessions run once a week for 90 minutes from March to June, and from September to November. There is no charge or fee for our program.  The more flexible you are the easier it will be for us to find you a spot in our program. Our Rancher Coordinator will confirm via email or phone call before we officially place ​you in a specific time slot as we realize your schedule may change periodically.

If our sessions are already full, we will put your child/rancher on a waiting list and contact you as soon as we have an open spot.  Our days and session times completely revolve around our seasonal volunteer supervisors’ schedules so we may have more/less session times available each new season.

RELEASE OF LIABILITY AND HOLD HARMLESS AGREEMENT

The undersigned participant, and his or her parent or legal guardian if the participant is under the age of 18 years old, is aware that equine activities in which the participant may directly or indirectly engage, whether mounted or un-mounted, to include but not be limited to:  horseback riding, training, driving, jumping or otherwise being a passenger upon an equine; and also handling, leading, grooming and otherwise attending to the equine, are activities and events which pose potentially serious risks of injuries or death to the participants.  I understand that the participant may be injured or die as a result of the participant’s negligence, the negligence of others, or through no fault of the participant or anyone else but because of the nature of the activity in which the participant is going to be engaged.  I also understand that horses, even the most well-trained, are unpredictable and may be difficult to control.

With this waiver, I accept notice of the provisions of the Equine Activity Liability Act, Sections 3.2-6200 through 3.2-6203 of the Code of Virginia, 1950, as amended, which state in part, the intrinsic dangers or conditions that are an integral part of equine activities, including but not limited to (i) the propensity of an equine to behave in ways that may result in injury, harm or death to persons on or around them; (ii) the unpredictability of an equine’s reaction to sounds, sudden movements, and unfamiliar objects, persons or other animals; (iii) certain hazards such as surface and subsurface conditions; (iv) collisions with other animals or objects; and (v) the potential of a participant acting in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the equine or not acting within the participant’s ability.  This waiver shall remain valid unless expressly revoked by me, or if a minor, by a parent or guardian, in writing, with receipt acknowledged in writing by an agent/director of the Wings of Hope Ranch.

Furthermore, with this waiver, I expressly assume the risk of injury or death due to the ordinary negligence of the Wings of Hope Ranch, located at 14505 West Patrick Henry Rd, Montpelier, VA 23192 and any and all of its employees, agents, volunteers, and representatives; however, I understand that this release is not intended to prevent or limit liability in the event of gross negligence or willful misconduct by any of the aforementioned parties.   

With knowledge of the foregoing, and as an inducement for the participant’s ability to participate in equine activities at the Wings of Hope Ranch, I hereby agree to waive and release any and all rights that I or my heirs may have to make a claim against the Wings of Hope Ranch and all its agents, employees, representatives and volunteers, arising from any damages, injury or death which the participant might sustain while engaging in equine activities at the Wings of Hope Ranch.  I further agree to indemnify and hold harmless the Wings of Hope Ranch, its agents, representatives and volunteers from any claims which I might make or which might be made on my behalf by others or which might be made against the Wings of Hope Ranch by others, arising from the participant’s equine activities at the Wings of Hope Ranch.  Furthermore, I agree to indemnify the Wings of Hope Ranch for any injury, death, loss or damage to any personal property when suck injury, death, loss or damage arises from the participant’s equine activities at the Wings of Hope Ranch or at an event hosted by the Wings of Hope.

BY SIGNING THIS WAIVER AND RELEASE, I UNDERSTAND THAT I AM GIVING UP, WAIVING AND RELEASING, ANY RIGHT I MIGHT HAAVE TO SUE OR MAKE A CLAIM AGAINST THE WINGS OF HOPE RANCH AND ANY OF ITS AGENTS, EMPLOYEES, VOLUNTEERS OR REPRESENTATIVES, FOR ANY INJURIES THE PARTICIPANT MIGHT SUSTAIN TO ITS PERSON OR ITS PERSONAL PROPERTY, WHILE HORSEBACK RIDING OR UNMOUNTED, IN AN EQUINE ACTIVITY AT THE WINGS OF HOPE RANCH, AND THAT I AM INDEMNIFYING AND HOLDING HARMLESS, THE WINGS OF HOPE RANCH AND ALL OF ITS EMPLOYEES, AGENTS, VOLUNTEERS OR REPRESENTATIVES, FOR INJURIES TO ANYONE ELSE OR ANY HORSE RIDDEN BY ANOTHER WHILE I AM ENGAGED IN EQUINE ACTIVITIES AT THE WINGS OF HOPE RANCH.  IT IS MY INTENT TO GIVE UP THOSE RIGHTS AND PROVIDE THIS HOLD HARMLESS AGREEMENT AND I DO SO KNOWINGLY AND VOLUNTARILY.

Today's Date: November 16, 2019

First Rancher Name

First Name*

Middle Name

Last Name*

Phone*
First Rancher Date of Birth*
First Rancher Information
Please check any/all desired sessions your child may be able to attend, the more flexible you are the easier it will be for us to find you a spot in our program.
4:30PM - 6:00PM Mondays
5:30PM - 7:00PM Mondays
4:30PM - 6:00PM Tuesdays
5:30PM - 7:00PM Tuesdays
4:30PM - 6:00PM Wednesdays
5:30PM - 7:00PM Wednesdays
4:30PM - 6:00PM Thursdays
5:30PM - 7:00PM Thursdays
5:30PM - 7:00PM Fridays
4:30PM - 6:00PM Sundays
5:30PM - 7:00PM Sundays

My child has: (Please describe the conflict or challenge that has brought you to Wings of Hope Ranch)
Food Allergies or Other Allergies we should know about:*
No
Yes

If yes, describe:

Communication Skills:

What are your goals for you child with regards to their participation in this ministry?

Triggers for behaviors of resistance/frustration/aggression (please describe expected behaviors and known specific triggers):

Best calming approach when upset or frustrated:

Best advice for the adult or youth leader that will be assigned to work with my child:
Please chose Yes to give us permission to share this information with your child's assigned volunteer and session supervisor to best help your child:*
No
Yes
Click to customize question*
No
Yes

WINGS OF HOPE RANCH Photo and Video Release Form

1. Authorize and consent to the Organization taking one or more photographs (the "Photograph(s)") or videos (the "Video(s)") of the Child for the sole purpose of using on our website and/or newsletters, videos and advertisements (the "Purpose"). 2. Agree that the Photograph(s) and/or Video(s), any royalties, rights, benefits or other privileges therefrom shall be and become the exclusive property of the Organization and hereby assign to the Organization, any and all right, title and interest that I may have in and to the Photograph(s), and further agree to give the Organization all assistance reasonably required to protect and perfect the Organization's right in the Photograph(s), and/or Video(s).*
No
Yes

If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor, the date that you obtained legal custody and provide copy on first day of session.
First Rancher Signature*
Second Rancher Name

First Name*

Middle Name

Last Name*
Second Rancher Date of Birth*
Second Rancher Information
Please check any/all desired sessions your child may be able to attend, the more flexible you are the easier it will be for us to find you a spot in our program.
4:30PM - 6:00PM Mondays
5:30PM - 7:00PM Mondays
4:30PM - 6:00PM Tuesdays
5:30PM - 7:00PM Tuesdays
4:30PM - 6:00PM Wednesdays
5:30PM - 7:00PM Wednesdays
4:30PM - 6:00PM Thursdays
5:30PM - 7:00PM Thursdays
5:30PM - 7:00PM Fridays
4:30PM - 6:00PM Sundays
5:30PM - 7:00PM Sundays

My child has: (Please describe the conflict or challenge that has brought you to Wings of Hope Ranch)
Food Allergies or Other Allergies we should know about:*
No
Yes

If yes, describe:

Communication Skills:

What are your goals for you child with regards to their participation in this ministry?

Triggers for behaviors of resistance/frustration/aggression (please describe expected behaviors and known specific triggers):

Best calming approach when upset or frustrated:

Best advice for the adult or youth leader that will be assigned to work with my child:
Please chose Yes to give us permission to share this information with your child's assigned volunteer and session supervisor to best help your child:*
No
Yes
Click to customize question*
No
Yes

WINGS OF HOPE RANCH Photo and Video Release Form

1. Authorize and consent to the Organization taking one or more photographs (the "Photograph(s)") or videos (the "Video(s)") of the Child for the sole purpose of using on our website and/or newsletters, videos and advertisements (the "Purpose"). 2. Agree that the Photograph(s) and/or Video(s), any royalties, rights, benefits or other privileges therefrom shall be and become the exclusive property of the Organization and hereby assign to the Organization, any and all right, title and interest that I may have in and to the Photograph(s), and further agree to give the Organization all assistance reasonably required to protect and perfect the Organization's right in the Photograph(s), and/or Video(s).*
No
Yes

If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor, the date that you obtained legal custody and provide copy on first day of session.
Third Rancher Name

First Name*

Middle Name

Last Name*
Third Rancher Date of Birth*
Third Rancher Information
Please check any/all desired sessions your child may be able to attend, the more flexible you are the easier it will be for us to find you a spot in our program.
4:30PM - 6:00PM Mondays
5:30PM - 7:00PM Mondays
4:30PM - 6:00PM Tuesdays
5:30PM - 7:00PM Tuesdays
4:30PM - 6:00PM Wednesdays
5:30PM - 7:00PM Wednesdays
4:30PM - 6:00PM Thursdays
5:30PM - 7:00PM Thursdays
5:30PM - 7:00PM Fridays
4:30PM - 6:00PM Sundays
5:30PM - 7:00PM Sundays

My child has: (Please describe the conflict or challenge that has brought you to Wings of Hope Ranch)
Food Allergies or Other Allergies we should know about:*
No
Yes

If yes, describe:

Communication Skills:

What are your goals for you child with regards to their participation in this ministry?

Triggers for behaviors of resistance/frustration/aggression (please describe expected behaviors and known specific triggers):

Best calming approach when upset or frustrated:

Best advice for the adult or youth leader that will be assigned to work with my child:
Please chose Yes to give us permission to share this information with your child's assigned volunteer and session supervisor to best help your child:*
No
Yes
Click to customize question*
No
Yes

WINGS OF HOPE RANCH Photo and Video Release Form

1. Authorize and consent to the Organization taking one or more photographs (the "Photograph(s)") or videos (the "Video(s)") of the Child for the sole purpose of using on our website and/or newsletters, videos and advertisements (the "Purpose"). 2. Agree that the Photograph(s) and/or Video(s), any royalties, rights, benefits or other privileges therefrom shall be and become the exclusive property of the Organization and hereby assign to the Organization, any and all right, title and interest that I may have in and to the Photograph(s), and further agree to give the Organization all assistance reasonably required to protect and perfect the Organization's right in the Photograph(s), and/or Video(s).*
No
Yes

If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor, the date that you obtained legal custody and provide copy on first day of session.
Fourth Rancher Name

First Name*

Middle Name

Last Name*
Fourth Rancher Date of Birth*
Fourth Rancher Information
Please check any/all desired sessions your child may be able to attend, the more flexible you are the easier it will be for us to find you a spot in our program.
4:30PM - 6:00PM Mondays
5:30PM - 7:00PM Mondays
4:30PM - 6:00PM Tuesdays
5:30PM - 7:00PM Tuesdays
4:30PM - 6:00PM Wednesdays
5:30PM - 7:00PM Wednesdays
4:30PM - 6:00PM Thursdays
5:30PM - 7:00PM Thursdays
5:30PM - 7:00PM Fridays
4:30PM - 6:00PM Sundays
5:30PM - 7:00PM Sundays

My child has: (Please describe the conflict or challenge that has brought you to Wings of Hope Ranch)
Food Allergies or Other Allergies we should know about:*
No
Yes

If yes, describe:

Communication Skills:

What are your goals for you child with regards to their participation in this ministry?

Triggers for behaviors of resistance/frustration/aggression (please describe expected behaviors and known specific triggers):

Best calming approach when upset or frustrated:

Best advice for the adult or youth leader that will be assigned to work with my child:
Please chose Yes to give us permission to share this information with your child's assigned volunteer and session supervisor to best help your child:*
No
Yes
Click to customize question*
No
Yes

WINGS OF HOPE RANCH Photo and Video Release Form

1. Authorize and consent to the Organization taking one or more photographs (the "Photograph(s)") or videos (the "Video(s)") of the Child for the sole purpose of using on our website and/or newsletters, videos and advertisements (the "Purpose"). 2. Agree that the Photograph(s) and/or Video(s), any royalties, rights, benefits or other privileges therefrom shall be and become the exclusive property of the Organization and hereby assign to the Organization, any and all right, title and interest that I may have in and to the Photograph(s), and further agree to give the Organization all assistance reasonably required to protect and perfect the Organization's right in the Photograph(s), and/or Video(s).*
No
Yes

If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor, the date that you obtained legal custody and provide copy on first day of session.
Fifth Rancher Name

First Name*

Middle Name

Last Name*
Fifth Rancher Date of Birth*
Fifth Rancher Information
Please check any/all desired sessions your child may be able to attend, the more flexible you are the easier it will be for us to find you a spot in our program.
4:30PM - 6:00PM Mondays
5:30PM - 7:00PM Mondays
4:30PM - 6:00PM Tuesdays
5:30PM - 7:00PM Tuesdays
4:30PM - 6:00PM Wednesdays
5:30PM - 7:00PM Wednesdays
4:30PM - 6:00PM Thursdays
5:30PM - 7:00PM Thursdays
5:30PM - 7:00PM Fridays
4:30PM - 6:00PM Sundays
5:30PM - 7:00PM Sundays

My child has: (Please describe the conflict or challenge that has brought you to Wings of Hope Ranch)
Food Allergies or Other Allergies we should know about:*
No
Yes

If yes, describe:

Communication Skills:

What are your goals for you child with regards to their participation in this ministry?

Triggers for behaviors of resistance/frustration/aggression (please describe expected behaviors and known specific triggers):

Best calming approach when upset or frustrated:

Best advice for the adult or youth leader that will be assigned to work with my child:
Please chose Yes to give us permission to share this information with your child's assigned volunteer and session supervisor to best help your child:*
No
Yes
Click to customize question*
No
Yes

WINGS OF HOPE RANCH Photo and Video Release Form

1. Authorize and consent to the Organization taking one or more photographs (the "Photograph(s)") or videos (the "Video(s)") of the Child for the sole purpose of using on our website and/or newsletters, videos and advertisements (the "Purpose"). 2. Agree that the Photograph(s) and/or Video(s), any royalties, rights, benefits or other privileges therefrom shall be and become the exclusive property of the Organization and hereby assign to the Organization, any and all right, title and interest that I may have in and to the Photograph(s), and further agree to give the Organization all assistance reasonably required to protect and perfect the Organization's right in the Photograph(s), and/or Video(s).*
No
Yes

If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor, the date that you obtained legal custody and provide copy on first day of session.
Sixth Rancher Name

First Name*

Middle Name

Last Name*
Sixth Rancher Date of Birth*
Sixth Rancher Information
Please check any/all desired sessions your child may be able to attend, the more flexible you are the easier it will be for us to find you a spot in our program.
4:30PM - 6:00PM Mondays
5:30PM - 7:00PM Mondays
4:30PM - 6:00PM Tuesdays
5:30PM - 7:00PM Tuesdays
4:30PM - 6:00PM Wednesdays
5:30PM - 7:00PM Wednesdays
4:30PM - 6:00PM Thursdays
5:30PM - 7:00PM Thursdays
5:30PM - 7:00PM Fridays
4:30PM - 6:00PM Sundays
5:30PM - 7:00PM Sundays

My child has: (Please describe the conflict or challenge that has brought you to Wings of Hope Ranch)
Food Allergies or Other Allergies we should know about:*
No
Yes

If yes, describe:

Communication Skills:

What are your goals for you child with regards to their participation in this ministry?

Triggers for behaviors of resistance/frustration/aggression (please describe expected behaviors and known specific triggers):

Best calming approach when upset or frustrated:

Best advice for the adult or youth leader that will be assigned to work with my child:
Please chose Yes to give us permission to share this information with your child's assigned volunteer and session supervisor to best help your child:*
No
Yes
Click to customize question*
No
Yes

WINGS OF HOPE RANCH Photo and Video Release Form

1. Authorize and consent to the Organization taking one or more photographs (the "Photograph(s)") or videos (the "Video(s)") of the Child for the sole purpose of using on our website and/or newsletters, videos and advertisements (the "Purpose"). 2. Agree that the Photograph(s) and/or Video(s), any royalties, rights, benefits or other privileges therefrom shall be and become the exclusive property of the Organization and hereby assign to the Organization, any and all right, title and interest that I may have in and to the Photograph(s), and further agree to give the Organization all assistance reasonably required to protect and perfect the Organization's right in the Photograph(s), and/or Video(s).*
No
Yes

If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor, the date that you obtained legal custody and provide copy on first day of session.
Seventh Rancher Name

First Name*

Middle Name

Last Name*
Seventh Rancher Date of Birth*
Seventh Rancher Information
Please check any/all desired sessions your child may be able to attend, the more flexible you are the easier it will be for us to find you a spot in our program.
4:30PM - 6:00PM Mondays
5:30PM - 7:00PM Mondays
4:30PM - 6:00PM Tuesdays
5:30PM - 7:00PM Tuesdays
4:30PM - 6:00PM Wednesdays
5:30PM - 7:00PM Wednesdays
4:30PM - 6:00PM Thursdays
5:30PM - 7:00PM Thursdays
5:30PM - 7:00PM Fridays
4:30PM - 6:00PM Sundays
5:30PM - 7:00PM Sundays

My child has: (Please describe the conflict or challenge that has brought you to Wings of Hope Ranch)
Food Allergies or Other Allergies we should know about:*
No
Yes

If yes, describe:

Communication Skills:

What are your goals for you child with regards to their participation in this ministry?

Triggers for behaviors of resistance/frustration/aggression (please describe expected behaviors and known specific triggers):

Best calming approach when upset or frustrated:

Best advice for the adult or youth leader that will be assigned to work with my child:
Please chose Yes to give us permission to share this information with your child's assigned volunteer and session supervisor to best help your child:*
No
Yes
Click to customize question*
No
Yes

WINGS OF HOPE RANCH Photo and Video Release Form

1. Authorize and consent to the Organization taking one or more photographs (the "Photograph(s)") or videos (the "Video(s)") of the Child for the sole purpose of using on our website and/or newsletters, videos and advertisements (the "Purpose"). 2. Agree that the Photograph(s) and/or Video(s), any royalties, rights, benefits or other privileges therefrom shall be and become the exclusive property of the Organization and hereby assign to the Organization, any and all right, title and interest that I may have in and to the Photograph(s), and further agree to give the Organization all assistance reasonably required to protect and perfect the Organization's right in the Photograph(s), and/or Video(s).*
No
Yes

If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor, the date that you obtained legal custody and provide copy on first day of session.
Eighth Rancher Name

First Name*

Middle Name

Last Name*
Eighth Rancher Date of Birth*
Eighth Rancher Information
Please check any/all desired sessions your child may be able to attend, the more flexible you are the easier it will be for us to find you a spot in our program.
4:30PM - 6:00PM Mondays
5:30PM - 7:00PM Mondays
4:30PM - 6:00PM Tuesdays
5:30PM - 7:00PM Tuesdays
4:30PM - 6:00PM Wednesdays
5:30PM - 7:00PM Wednesdays
4:30PM - 6:00PM Thursdays
5:30PM - 7:00PM Thursdays
5:30PM - 7:00PM Fridays
4:30PM - 6:00PM Sundays
5:30PM - 7:00PM Sundays

My child has: (Please describe the conflict or challenge that has brought you to Wings of Hope Ranch)
Food Allergies or Other Allergies we should know about:*
No
Yes

If yes, describe:

Communication Skills:

What are your goals for you child with regards to their participation in this ministry?

Triggers for behaviors of resistance/frustration/aggression (please describe expected behaviors and known specific triggers):

Best calming approach when upset or frustrated:

Best advice for the adult or youth leader that will be assigned to work with my child:
Please chose Yes to give us permission to share this information with your child's assigned volunteer and session supervisor to best help your child:*
No
Yes
Click to customize question*
No
Yes

WINGS OF HOPE RANCH Photo and Video Release Form

1. Authorize and consent to the Organization taking one or more photographs (the "Photograph(s)") or videos (the "Video(s)") of the Child for the sole purpose of using on our website and/or newsletters, videos and advertisements (the "Purpose"). 2. Agree that the Photograph(s) and/or Video(s), any royalties, rights, benefits or other privileges therefrom shall be and become the exclusive property of the Organization and hereby assign to the Organization, any and all right, title and interest that I may have in and to the Photograph(s), and further agree to give the Organization all assistance reasonably required to protect and perfect the Organization's right in the Photograph(s), and/or Video(s).*
No
Yes

If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor, the date that you obtained legal custody and provide copy on first day of session.
Ninth Rancher Name

First Name*

Middle Name

Last Name*
Ninth Rancher Date of Birth*
Ninth Rancher Information
Please check any/all desired sessions your child may be able to attend, the more flexible you are the easier it will be for us to find you a spot in our program.
4:30PM - 6:00PM Mondays
5:30PM - 7:00PM Mondays
4:30PM - 6:00PM Tuesdays
5:30PM - 7:00PM Tuesdays
4:30PM - 6:00PM Wednesdays
5:30PM - 7:00PM Wednesdays
4:30PM - 6:00PM Thursdays
5:30PM - 7:00PM Thursdays
5:30PM - 7:00PM Fridays
4:30PM - 6:00PM Sundays
5:30PM - 7:00PM Sundays

My child has: (Please describe the conflict or challenge that has brought you to Wings of Hope Ranch)
Food Allergies or Other Allergies we should know about:*
No
Yes

If yes, describe:

Communication Skills:

What are your goals for you child with regards to their participation in this ministry?

Triggers for behaviors of resistance/frustration/aggression (please describe expected behaviors and known specific triggers):

Best calming approach when upset or frustrated:

Best advice for the adult or youth leader that will be assigned to work with my child:
Please chose Yes to give us permission to share this information with your child's assigned volunteer and session supervisor to best help your child:*
No
Yes
Click to customize question*
No
Yes

WINGS OF HOPE RANCH Photo and Video Release Form

1. Authorize and consent to the Organization taking one or more photographs (the "Photograph(s)") or videos (the "Video(s)") of the Child for the sole purpose of using on our website and/or newsletters, videos and advertisements (the "Purpose"). 2. Agree that the Photograph(s) and/or Video(s), any royalties, rights, benefits or other privileges therefrom shall be and become the exclusive property of the Organization and hereby assign to the Organization, any and all right, title and interest that I may have in and to the Photograph(s), and further agree to give the Organization all assistance reasonably required to protect and perfect the Organization's right in the Photograph(s), and/or Video(s).*
No
Yes

If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor, the date that you obtained legal custody and provide copy on first day of session.
Tenth Rancher Name

First Name*

Middle Name

Last Name*
Tenth Rancher Date of Birth*
Tenth Rancher Information
Please check any/all desired sessions your child may be able to attend, the more flexible you are the easier it will be for us to find you a spot in our program.
4:30PM - 6:00PM Mondays
5:30PM - 7:00PM Mondays
4:30PM - 6:00PM Tuesdays
5:30PM - 7:00PM Tuesdays
4:30PM - 6:00PM Wednesdays
5:30PM - 7:00PM Wednesdays
4:30PM - 6:00PM Thursdays
5:30PM - 7:00PM Thursdays
5:30PM - 7:00PM Fridays
4:30PM - 6:00PM Sundays
5:30PM - 7:00PM Sundays

My child has: (Please describe the conflict or challenge that has brought you to Wings of Hope Ranch)
Food Allergies or Other Allergies we should know about:*
No
Yes

If yes, describe:

Communication Skills:

What are your goals for you child with regards to their participation in this ministry?

Triggers for behaviors of resistance/frustration/aggression (please describe expected behaviors and known specific triggers):

Best calming approach when upset or frustrated:

Best advice for the adult or youth leader that will be assigned to work with my child:
Please chose Yes to give us permission to share this information with your child's assigned volunteer and session supervisor to best help your child:*
No
Yes
Click to customize question*
No
Yes

WINGS OF HOPE RANCH Photo and Video Release Form

1. Authorize and consent to the Organization taking one or more photographs (the "Photograph(s)") or videos (the "Video(s)") of the Child for the sole purpose of using on our website and/or newsletters, videos and advertisements (the "Purpose"). 2. Agree that the Photograph(s) and/or Video(s), any royalties, rights, benefits or other privileges therefrom shall be and become the exclusive property of the Organization and hereby assign to the Organization, any and all right, title and interest that I may have in and to the Photograph(s), and further agree to give the Organization all assistance reasonably required to protect and perfect the Organization's right in the Photograph(s), and/or Video(s).*
No
Yes

If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor, the date that you obtained legal custody and provide copy on first day of session.
Rancher 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*
I am/are the parent(s) or guardian of a Minor, and on the minor’s behalf and on my/our own behalf as the parent or guardian of the minor, I/we accept the release and waiver of liability contained within this form as an inducement for allowing my/our child, or this minor, to participate in equine activities which may occur at Wings of Hope Ranch. I/We have carefully read and understand the provisions as stated above, particularly, the INTRINSIC DANGERS associated with all equine activities. I/We further authorize emergency medical care which may be necessary. I/We represent and warrant that I/we have the legal authority to give this release. Note: If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor and the date that you obtained legal custody.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Please check any/all desired sessions your child may be able to attend, the more flexible you are the easier it will be for us to find you a spot in our program.
4:30PM - 6:00PM Mondays
5:30PM - 7:00PM Mondays
4:30PM - 6:00PM Tuesdays
5:30PM - 7:00PM Tuesdays
4:30PM - 6:00PM Wednesdays
5:30PM - 7:00PM Wednesdays
4:30PM - 6:00PM Thursdays
5:30PM - 7:00PM Thursdays
5:30PM - 7:00PM Fridays
4:30PM - 6:00PM Sundays
5:30PM - 7:00PM Sundays

My child has: (Please describe the conflict or challenge that has brought you to Wings of Hope Ranch)
Food Allergies or Other Allergies we should know about:*
No
Yes

If yes, describe:

Communication Skills:

What are your goals for you child with regards to their participation in this ministry?

Triggers for behaviors of resistance/frustration/aggression (please describe expected behaviors and known specific triggers):

Best calming approach when upset or frustrated:

Best advice for the adult or youth leader that will be assigned to work with my child:
Please chose Yes to give us permission to share this information with your child's assigned volunteer and session supervisor to best help your child:*
No
Yes
Click to customize question*
No
Yes

WINGS OF HOPE RANCH Photo and Video Release Form

1. Authorize and consent to the Organization taking one or more photographs (the "Photograph(s)") or videos (the "Video(s)") of the Child for the sole purpose of using on our website and/or newsletters, videos and advertisements (the "Purpose"). 2. Agree that the Photograph(s) and/or Video(s), any royalties, rights, benefits or other privileges therefrom shall be and become the exclusive property of the Organization and hereby assign to the Organization, any and all right, title and interest that I may have in and to the Photograph(s), and further agree to give the Organization all assistance reasonably required to protect and perfect the Organization's right in the Photograph(s), and/or Video(s).*
No
Yes

If you are not a biological parent of the minor, please provide the court jurisdiction which granted you legal custody of the minor, the date that you obtained legal custody and provide copy on first day of session.
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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