2026 Camp Parental Release / Medical Information / Code of Conduct

  • 2026 Camp Parental Release / Medical Information / Code of Conduct

    Step 1: Complete this online form. You will need the student present for the Code of Conduct section. Step 2: When you receive the email confirmation, forward that email to the student's teacher.

  • General Information

  • Male/Female*

  • Which week(s) is your child attending?*

  • Each week selected is $525 per week

  • Payment Information

    There is a Non-Refundable $155 registration fee due upon form submission.
  • Preferred Method of Remaining Payment(s)

  • Release of Liability for Participating in Equine Activities

    Each participant and parent signing below agrees to the following (on behalf of themselves and their minor child/children:

  • Inherent High Risk: Participants in activities at Hana Poulin Dressage & Driving, LLC fully understand and  acknowledge that activities involving equines are considered inherently high-risk activities. Horses have a  mind of their own and are large, powerful animals; they may injure a person. Participants realize that they are at  risk of being injured in numerous ways in the activities related to working with or riding horses including  without limitation use of equipment, facilities or transportation connected with the equine activities, which may  include without limitation that they may be thrown, fall, be bitten, kicked, stepped on, taken-off with, run-over,  dragged, struck, crushed or subject of other bodily injury, disease or illness, strains, fractures, partial and/or total  paralysis, death or other ailments that could cause serious disability and loss of, or damage to, possessions.  These risks and dangers may arise from negligence, accident or any other foreseeable or unforeseeable causes.  

    Assumption of Risk: By participation in equine activities, including without limitation use of equipment,  facilities or transportation connected with these activities, participant hereby assumes all risks and dangers and  all responsibility for any losses and/or damages relating to the equine activities, whether caused by negligence,  accident or any other foreseeable or unforeseeable causes.  

    Release of Liability: Participant, on behalf of himself/herself, named child, guests and their personal  representatives and heirs hereby voluntarily and knowingly, with understanding and acceptance of all risks,  forever releases, waives, discharges and holds harmless, and agrees to defend and indemnify Hana Poulin  Dressage & Driving, LLC and its owners from any and all present and future claims, actions or losses for bodily  injury, property damage, wrongful death, loss of services or any other cause of action which may arise out of  participant’s or his/her child’s or guest’s presence at or participation in equine activities at Hana Poulin  Dressage & Driving, LLC or with Hana Poulin Dressage & Driving, LLC personnel and/or use of  transportation, facilities or equipment related to such activities, whether caused by negligence, accident or any  other foreseeable or unforeseeable causes.  

    Participant is responsible for full and complete insurance coverage on his/her horse, personal property  and himself.
    Without limiting the foregoing, Hana Poulin Dressage & Driving, LLC, its owners, and the owners of  the trails we ride are not liable for: Any accident or injury to rider, volunteer, guest, horse, horse owner, his/her companions or horse  owner’s authorized riders. 
    Damage to or the theft of any tack or other personal belongings of the above mentioned.  o Any accident or injury to anyone involved in any equine or other related activities on the  property of Hana Poulin Dressage & Driving, LLC. This includes injuries that may result from  any activity related to handling, riding or working around any horses on the premises, including  without limitation, cleaning stalls, being in the hayloft, feeding, transporting or turning out other  horses and any other similar or dissimilar activities.  
    If any provision of this document is held invalid or unenforceable, it shall be conformed to the minimum  requirements of law to the extent possible, and in any event shall not affect any other provision, which shall  remain valid and enforceable. By signing below, participant and parent certifies that he/she and his/her minor  child is sufficiently knowledgeable and trained to ride, work with and be in the presence of horses and that he/ she has read the rules of the farm and AGREES NOT TO SUE.

  • Date of Signature
     - -

  • Camper Medical Information

  • Camper Date of Birth*
     - -
  • Do you have Health Insurance coverage for the camper?*
  • Does the camper have any allergies?*
  • Does the camper have an epi-pen? If so, they must keep it with them at all times!
  • Has the the camper been diagnosed with asthma by a physician?*

  • IMPORTANT: If your child has been diagnosed with asthma by a physician and has an inhaler they MUST bring such treatment wtih them to camp or they will not be allowed to stay at camp!

     

    If your child has an inhaler, they must keep it with them at ALL TIMES during camp!

  • Does the camper have any special food restrictions?*
  • Does the camper take any medications they will take during the day of camp?*

  • IMPORTANT: All medications must be in the original package (daily sorters/pill keepers are not permitted.)

    Please only send enough medication for the day of camp.

  • Does the camper have any other significant health history (heart condition, diabetes, any injury) or does the camper have any restrictions/medical conditions that the staff needs to be aware of?*

  • Over the Counter Medications Permitted

    Please select Yes or No to the following medications your child may or may not be given at camp

  • May we give your child...

  • Tylenol?*
  • Ibuprofen?*
  • Tums?*
  • Claritin?*
  • Benadryl?*
  • Neosporin?*
  • Hydrocortisone Cream?*
  • Aleve?*

  • Emergency Contacts

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  • Medical Information Signature

  • I have read and understand the statements in this release form.  I understand that should a health problem arise, I will be notified but if I cannot be reached by telephone I consent to emergency medical treatment, which may include surgery for my child as deemed necessary by competent medical personnel.  I also consent to the release of information for insurance purposes. 

  • Date of Signature*
     - -

  • Camper Code of Conduct

    This section must be completed by the Parent/Guardian. Please read this section together so your Camper can understand the expectations too.

  • Parent/Guardian: Please sign the bottom of this form to show your intent to support the implementation of this Code of Conduct in regards to your child.

    1. Camp begins each day at 9am and ends at 4pm. All students must have all equipment they used put away and have their work area swept and lunch area cleaned up by the conclusion of camp.
    2. Students should bring a snack, a water bottle and a lunch.
    3. Proper riding attire is mandatory. Correct riding boots, breeches and/or jeans, as well as an ASTM approved helmet are required. (There are some helmets available on a first come first serve basis.) PLEASE NO high heels, sandals or boots with large tread or street type shoes (aka sneakers) allowed.
    4. Team work is a major factor in this camp. All students are expected to be on their best behavior and are expected to work with the other campers. Campers who do not follow rules will be sent home.
    5. A non-refundable deposit of $155 is required upon completion of this form and all final payments are due 2 weeks prior to camp arrival. The camp fee is non-refundable unless there is an unexpected illness accompanied by a doctor's note.
    6. The camp involves hands-on work with horses and equine related equipment. Under New Hampshire law, an equine professional or activity sponsor, or any other person engaged in an equine activity is not liable for an injury of the death of anyone participating in an equine activity resulting from their inherent risks (HB 793).
    7. Riding and driving times will vary by day. There will be a minimum of 1-2 hours of riding and driving each day, not to exceed 3 hours. Students are responsible for proper cooling down of their assigned horse, and for putting their horse away or returning it outside.
    8. Any student exhibiting poor attitude, poor sportsmandhsip, or disrespect for an employee, other students, horses or borders of Hana Poulin Dressage & Driving LLC will be sent home, and their behavior will be reviewed to determine if they will be excluded from furture programs offered at Hana Poulin Dressage & Driving LLC.

  • Parent/Guardian agrees:

    I have read and understand the Code of Conduct above. I agree to abide by it for the safety and enjoyment of my camper and of other campers. I understand the consequences of my child failing to meet these guidelines.

  • Date of Signature*
     - -

  • Be certain to enter your email address correctly on the registration form to receive confirmation via email within 2 weeks.

  • Camp Registration Payment*

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