Camp Intake - Waiver and Informed Consent

Emergency Contract Form
Name of Participant*

First NameLast Name
Name of Parent/Guardian if under 18 Years Old*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Emergency Contact (Other than Parent/Guardian Listed Above)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Participant*
List of Persons approved to pick up and/or assume responsibility for your child (Include Phone Number)

BOULDER POINTE WAIVER AND INFORMED CONSENT TO PARTIPATE IN EQUESTRIAN ACTIVITIES
NOTICE: Please read this document. Signing or acknowledging review of this document affirms that you have read it and understand it in its entirety. The Equine Activity Liability laws of the State of Minnesota, Ch. 604A.12 Subdivision 2, requires the following notice:

NOTICE OF INHERENT RISKS: Equines have the propensity to behave in ways that may result in injury, harm or death to persons on or around the equine; have unpredictable reactions to such things as sounds, sudden movement and unfamiliar objects, persons or other animals; are susceptible to certain hazards such as surface or subsurface conditions, collisions with other equines or objects; propensities include kicking, biting, stamping, stumbling, rearing, and others; tack equipment can fail resulting in falling or loss of control; and activities have the potential of a participant to act 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. Equine activities are INHERENTLY DANGEROUS.
WAIVER AND INFORMED CONSENT TO PARTICIPATE

I, the undersigned, having read and understood the content of this document, agree and consent to the provisions contained herein. It is my intention and desire to participate in equestrian-related activities including but not limited to, riding, horse-handling or being present at equestrian activities as an observer or other activity related, however slight, to equestrian activities at events held at Boulder Pointe owned or leased facilities and their foster host facilities.

I hereby acknowledge that I am fully aware of the nature, purpose and risks of equine activities. I acknowledge that these activities are potentially dangerous and that I voluntarily accept any of the inherent risks involved. In consideration for my being permitted to take part in these activities, I agree to be bound by the rules and to obey the directions of the owners. I agree to release, hold harmless, and keep indemnified Boulder Pointe Equestrian & Event Center, LLC, its Members, officers and Andrea Keacher/Andrea Gustafson from and against all claims, actions, costs, expenses and demands in respect to death, injury, loss or damage to my person or property, howsoever caused, arising out of or in connection with my taking part in these events even if the same may have been contributed to or occasioned by the negligence of the said body or any of its agents, servants, or representatives. It is understood and agreed that this agreement is to be binding upon myself, my heirs, executors and assigns under the laws of the State of Minnesota related to Equine Activity Liability.

I UNDERSTAND THAT THIS IS A LEGAL DOCUMENT. I HAVE READ AND UNDERSTOOD THIS RELEASE AND I UNDERSTAND ALL ITS TERMS. I EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS MEANING AND SIGNFICANCE. I HEREBY ASSUME ALL OF THE RISKS ASSOCIATED WITH EQUINE RELATED ACTIVITIES
I hereby give permission to the Company staff to secure emergency medical and/or surgical treatment for my child or myself while I am on the property or my child is in their care. All expenses of such care will be accepted by myself or the parent(s)/legal guardian, including fees for an ambulance, if deemed reasonably necessary by staff. Company will make attempts, when possible, to reach my emergency contact person or the parent/guardian prior to medical treatment; but this may not be possible in all situations.

The Rider must sign this document if the Rider is 18 years of age or older. A parent/guardian must sign this Release on behalf of a minor child (17 years of age or younger).
Name of Rider*

First NameLast Name
Name of Parent / Guardian (if applicable)

First NameLast Name
Signature of Rider if rider is 18 years age or older. Signature of parent/guardian if rider is a minor (17 years of age or younger)*

Clear
Date Signed*

MonthDayYear
Date
Email*
example@example.com

Acknowledgment of Policies Specific to Camps

Camp Refund Policy

30 or more days notice 100% minus processing fees.
25-29 days notice - 75% refund
15-24 days notice - 50% refund

Less than 15 days notice no refund unless for a documented medical reason, homesickness would not apply. If there is a documented medical reason there will be a 100% refund minus processing fees.

Use of Hand Stamps

For the purpose of organizing and keeping track of campers Boulder Pointe will mark the hands of campers with a colored stamp. The stamp color will indicate which group they will be a part of during the day and aid counselors in organizing activities.

Late Drop-Off and Pick Up Policy

Parents and guardians must contact Boulder Pointe if they will be late to pick up their camper. There will be a 15 minute grace period after the stated camp start and end time after which a fee of $1/minute late will be applied.

Parent Participation Policy

No parents are allowed to stay and watch the camp or come back to the barn early before designated pick-up time.
For the My Little Horse Camps, (1) parent is allowed to be with the child attending. No other adults or children are allowed.

Weather Policy

We will be outside unless deemed necessary to be inside. We will be inside if it is actively raining, thundering or lightening, or if heat index is 90 degrees or above.

Camp Dismissal Policy

We want to make sure every camp has a safe and positive experience. We reserve the right to dismiss any camper who violates our policy and will ask the parent to pick up their camper. A refund will not be issued in the event of a dismissal. The following behaviors are grounds for dismissal.

⁃ Damage to any Boulder Pointe property
⁃ Endangering themselves or those around them including but not limited to behaviors of aggression towards another person (s), behaviors that spook horses (running, screaming, throwing objects, etc.)
⁃ Disrespect/bullying towards other campers and staff both verbally and physically including name-calling and hurtful language.

Age Acknowledgement

My Little Horse Camp - Ages 2-5 (A precocious camper may prefer a day camp)

Day Camps (including 3 Day and Week Long) - Ages 6-15 - We make every effort to offer a stimulating horse experience for all ages. Depending on your child's experience and maturity level children ages 13-15 may be too old for this camp.

I confirm I have read, acknowledge, and accept the terms of the policies stated heretofore.
Acknowledged
Signature (Must be 18 y.o or older)*

Clear
Date of Signature*

MonthDayYear
Date
Should be Empty:

Boulder Pointe Camp Intake

Emergency Contract Form

BOULDER POINTE WAIVER AND INFORMED CONSENT TO PARTIPATE IN EQUESTRIAN ACTIVITIES