BEE CAVE RIDING CENTER - Camp Release Form

Only fill this form out if you registered directly with Kathy for an upcoming camp.

* We apologize for any inconvience, but we ask that you fill out one form per camper.
Camper Information

(ages 6 - 16)
Camper Name (First and Last) *
Age *
DOB *
Address *
City *
State *
Zip Code *
Parent Information
Parent / Guardian #1 *
Cell # *
Work #
Please enter a valid phone number.
Home #
Email Address *
example@example.com
Parent / Guardian #2
Cell #
Home #
Work #
Please enter a valid phone number.
Email Address
example@example.com
Emergency Contact(s)

minimum 1 required but you can enter up to 3
Emergency Contact #1 *
Phone *
Relationship *
Emergency Contact #2
Phone
Relationship
Emergency Contact #3
Phone
Relationship
Riding Experience *

Pre-Rider - never been on a horse Beginner - ridden a horse less than 5 minutes, little to no experience Intermediate - taken a few horseback riding lessons and performs basic riding skills Advanced - takes / has taken horseback riding lessons consistently
Please describe any riding experience you have or anything we should know about your experience with horses.
Please note: All horses and ponies are assigned by the Camps Director at their discretion. We take into consideration the age/weight/height/experience of campers to ensure a safe and enjoyable time at camp.
Medical History

please mark all the following that apply to camper
Contacts / Glasses Asthma Diabetes Siezure Disorder Activity Restrictions Emotional / Social Learning Other
If "Yes" to any of the above, please explain:
Allergies - non life-threatening environmental, medication, food Severe or life-threatening FOOD allergies Other Severe or life-threatenting allergies
Please list the allergen and describe the allergic reaction:
Physician & Insurance Information
Doctor's Name *
Type N/A if you currently do not have a doctor.
Phone
Location
I do not carry Medical Insurance currently
My Medical Insurance Company Information
Policy #
I/We agree that: Should medical treatment be required, I and/or my medical insurance shall pay for ALL such incurred expenses.
Hold Harmless Authorization for Pediatric Emergency Medical and/or Surgical Treatment
For the safety of Children, sound medical practice calls for this authorization. In emergencies, where the Parent/Legal Guardian or Emergency Contact of the Child cannot be reached - this form will be extremely important. The authorization granted by this form will be used only when absolutely necessary and only after every attempt has been made first to contact the Parent/Legal Guardian or Emergency Contact.

I hereby give my permission for my Child to attend Bee Cave Riding Center LLC "Camp". The Child herein described has permission to engage in all prescribed camp activities except as noted.

I hold harmless Bee Cave Riding Center LLC, and/or Riding Horses with Kathy Slack, LLC, and their employees, agents, servants and volunteers from all risk, liability, injury, damage and loss to all persons and property which may occur to my child during or resulting from participation in the program. Ihereby authorize Bee Cave Riding Center LLC, and/or Riding Horses with Kathy Slack, LLC to take measures in the event of a medical emergency.

I hereby give permission to the medical personnel selected by Bee Cave Riding Center LLC, and/or Riding Horses with Kathy Slack, LLC to order X-rays, routine tests, treatment, and necessary related transportation for my child.

In the event I cannot be reached in an emergency. I hereby give permission to the Physician of the hospital selected by Bee Cave Riding Center LLC, and/or Riding Horses with Kathy Slack, LLC to secure treatment, including hospitalization, for my Child as named above.
Signature of Parent/Guardian *

Clear
Date Signed *

Month Day Year
Date
Photo / Video Agreement
I give Bee Cave Riding Center permission to photograph and/or video me and/or my child for marketing purposes (website, social media, publications, and/or promotions) *

Yes
Waiver & Release
1.Registration of Participant and Agreement Purpose I above listed individual, and the parents or legal guardians thereof if a minor, do hereby voluntarily agree to participate in the equestrian services provided by this Bee Cave Riding Center LLC, and/or Riding Horses with Kathy Slack LLC.

2. Compliance of Rules: I/We agree to abide by all rules and regulations established by Bee Cave Riding Center LLC, and/or Riding Horses with Kathy Slack LLC and acknowledge that she has provided me with a copy of/or posted such rules and regulations in a clearly visible and prominent location and that I have reviewed them.

3. Protective Headgear: I/We agree that: I for myself and on behalf of my child and/or legal ward have been fully warned and advised by this stable that protective headgear/helmet should be worn while riding, handling, and/or being near horses. I acknowledge that I/We will be responsible for properly securing the headgear/helmet on the participants head at all times.

4. Proper Footwear: I/We agree that: anytime riding the proper heeled footwear will be worn.

5.Carry-On Objects Warning and Sharp, Loud Noises Warning: I/We acknowledge that: when approaching, mounting, and riding horses, I must not carry loose items that may fall of blow away or flap in the wind or bounce or make sharp or loud noises, the action of which may scare horses causing them to react in unsafe ways. Examples: Cameras, cell phones, hats. When near or riding a horse participant must not make sharp or loud noises, such as whistling or screaming or yelling, the sound of which may scare horses causing them to react in unsafe ways.

6. Saddle and Girth Loosening Warning: I/We acknowledge that: saddle girths (fastener straps around the horse's belly) may loosen during riding. Riders must alert the nearest attendant of any girth looseness so action can be taken to avoid saddle slippage and the potential for the to fall from the horse.

7.Release of Liability: I/We the undersigned do not hold Bee Cave Riding Center LLC, and/or Riding Horses with Kathy Slack LLC, and their employees liable for any accident or injuries, including death that occurs while the above named rider, myself, or any family member is on the premises of Bee Cave Riding Center. I/We understand the inherent danger of horses and horseback riding and accept the responsibility of our involvement in this sport.

WARNING: Under Texas Law (Chapter 87, Civil Practice and Remedies code) an Equine Professional is not liable for any injury to or the death of a participant in equine activities resulting from the inherent risk of equine activities.

I HEREBY CERTIFY THAT I HAVE READ & UNDERSTAND ALL OF THE FOREGOING TERMS OF THIS AGREEMENT & EXPRESSLY ASSENT THERETO.
Signature of Parent/Guardian *

Clear
Date Signed *

Month Day Year
Date
Camp Selection

(Camp Hours 9 AM - 5 PM, Early Drop-Off Available - Please contact Kathy)
Thanksgiving Camp *

November 21, 2022 November 22, 2022 November 23, 2022
Holiday Camp *

December 19, 2022 December 20, 2022 December 21, 2022 December 22, 2022 December 23, 2022
I have paid Kathy directly. (Please only hit if you have paid Kathy if you have not please leave it blank)

Yes
If you have paid Kathy please note the method of payment below.

Check Other
Should be Empty:

Camper Information

Parent Information

Emergency Contact(s)

Medical History

Physician & Insurance Information

Hold Harmless Authorization for Pediatric Emergency Medical and/or Surgical Treatment

Photo / Video Agreement

Waiver & Release

Camp Selection