Horsense Camper Waiver

How did you hear about Horsense*

If you were invited to participate by a school please write the name of the school below.

If you were invited to participate by a community organization please provide the name below.

Please provide name (optional).

If Other, please provide below.

Which Camp would you like to sign up for:*

Camp 1 Starting 10/26/24Camp 2 Starting 1/18/25Camp 3 Starting 3/1/25

Child's Name*

First NameLast Name

Childs Date of Birth*

Date

Child's Grade Level

School Name

Shirt Size (Adult Sizes)*

SmallMediumLargeExtra Large

Parent's Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number - Cell*

Please enter a valid phone number.

Phone Number - Daytime

Please enter a valid phone number.

Phone Number - Evening

Please enter a valid phone number.

Email*

example@example.com

Physician Name

First NameLast Name

Physician Name Phone Number

Please enter a valid phone number.

Known Allergies

Medications

Medical Conditions

My child can be picked up by:*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Relationship*

My child can be picked up by:

First NameLast Name

Phone Number

Please enter a valid phone number.

Relationship

PLEASE PROVIDE INFORMATION OF WHOM TO CONTACT IN THE EVENT OF AN EMERGENCY.

Emergency Contact 1*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Emergency Contact 2

First NameLast Name

Phone Number

Please enter a valid phone number.

EMERGENCY CARE AND PHOTO RELEASE

If the emergency contact cannot be reached, and there is a need for immediate medical attention, I hereby give the Horsense staff permission to obtain emergency treatment for my child and I will accept the bill(s) sent either to my home or to my insurance company. Furthermore, I hereby release Health World from any and all claims for injuries suffered by my child while participating in the camp. Lastly, if my child is photographed in the camp for an advertisement for Horsense, I authorize Health World’s use of my child’s image in future promotional campaigns. Transfers to another camp and special requests to be in camp with another child are based on availability and are not guaranteed. Heath World reserves the right to change the program, schedules and instructors when necessary.

Parent/Guardian Signature*

Child's Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian(s) Name(s)

First NameLast Name

Arizona Inherent Risk Law: Under Arizona law, pursuant to A.R.S. 12-533, an equine activity sponsor or professional shall not be liable for any injury to, or the death of a participant in equine activities resulting from the inherent risk of equine activities.

I acknowledge that horse back riding is a sport which carries inherent risks of injury and damage to myself or my child/ward and to my property. A horse may, without warning or any apparent cause: buck, stumble, fall, rear, make unpredictable movements, spook, jump obstacles, step on a person’s feet, push or shove a person, that saddles or bridles may loosen or break, any/all of which may cause the rider to fall or be jolted, resulting in serious injury or death. I knowingly assume all risks, whether known or unknown, of horseback riding in the Health World program called Horsense. I hereby release Health World and MacDonald’s Ranch, Inc. (hereinafter referred to as operators) from all liability for any act of negligence or want of ordinary care on the part of Health World and MacDonald’s Ranch, Inc., its employees, members, guests, directors, officers, volunteers, sponsors, or agents. In consideration of my participation in any and all activities organized or sponsored by the operators on the date(s) set forth above, I waive, release and discharge the operators, its directors, officers, agents, employees, volunteers, sponsors, and other riders, their liability for injury or damage to myself, my child or ward, or my property arising out of my participation in horse back riding or associated equine and program activities. This agreement is binding upon my executors, heirs, legal representatives and is good for all sessions and other events done in connection with this program.

COVID-19 Parental Acknowledgment and Disclosure: I have read, understand, and agree that, while present at the Horsense Camp, my child will be in contact with children and staff (volunteers) who are also at risk of community exposure. I understand that no list of restrictions, guidelines, or practices will remove the risk of exposure to COVID-19 I agree that I will indemnify and hold harmless the operators, officers, directors, employees, guests, volunteers, sponsors, and agents against all claims, demands, and causes of action, including court costs and actual attorney’s fees, arising from any proceeding or lawsuit brought by me or prosecuted for my benefit. I acknowledge that I have read and had the opportunity to read and discuss with my legal advisor, the RIDER’S ASSUMPTION OF RISK AND GENERAL RELEASE AGREEMENT and know and understand its contents.

Signature of Rider*

Rider Name*

First NameLast Name

Signature of Parent/Guardian*

Parent/Guardian Name*

First NameLast Name

HORSENSE CAMP REGISTRATION, EMERGENCY INFORMATION, AND PHOTO RELEASE FORM

RIDERS ASSUMPTION OF RISK & GENERAL RELEASE AGREEMENT