Blue Sky Moments Program

Participant Registration

and Guardian Consent form

Please fill out the participant information below if you are over 18 years old. 

* Legal Parent/Guardian or DFCS Case Manager if under 18:

Your child or teen has been invited to participate in our Blue Sky Moments program. We have trained volunteer mentors that have dedicated their time to serving each participant. Your child's mentor will only visit with him/her on-site during Blue Sky Moments scheduled sessions.

Your signature indicates your permission:

1. For your child to participate in the Blue Sky Moments program.

2. For pertinent information regarding your child, including but not limited to: history, challenges, strengths, interests and goals be distributed to the assigned volunteer mentor.

All information listed below is confidential and will only be seen by the Blue Sky Moments Executive Director, Program Director and your child's assigned volunteer mentor.

General Activity Release, Assumption of Risk and Waiver of Liability Agreement

IMPORTANT: THIS DOCUMENT WAIVES CERTAIN LEGAL RIGHTS. PLEASE READ CAREFULLY BEFORE SIGNING.

Assumption of Risk

I understand that participating in activities at Blue Sky Acres (“BSA”) involves inherent risks, including but not limited to:

• surface or subsurface hazards;
• the propensity of equines to behave unpredictably;
• sudden sounds, movements, or unfamiliar objects or animals;
• collisions with equines, animals, people, or objects;
• the actions of other participants, including failure to control an equine.
• I acknowledge these risks for myself and/or my child/ward and voluntarily choose to participate.

Release of Liability

In consideration of participation in activities at BSA, I, for myself, my child/ward, and our heirs, executors, and assigns, hereby release and hold harmless Blue Sky Acres, its Board of Directors, employees, volunteers, instructors, contractors, and affiliated organizations from any and all claims of injury, loss, or damage arising out of participation in BSA activities, including activities occurring outside the primary program such as property maintenance, work projects, transportation, caregiving, or horse exercising.

Georgia Equine / Farm Animal Liability Law

I acknowledge the following warning under Georgia law: “Under Georgia law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in an equine activity resulting from the inherent risk of equine activity.” (O.C.G.A. Title 4, Chapter 12)

Acknowledgment

By signing below, I acknowledge that:

• I have read and fully understand this document.
• I am signing voluntarily and without coercion.
• I understand that I am waiving certain legal rights.

PHOTO RELEASE 

1. Blue Sky Acres to use and reproduce any photograph or image in its print, online and video publications of me/my child/my ward for distribution to the public for promotional printed materials, educational activities or for any other use for the benefit of the program;
2. to release Blue Sky Acres, its employees and any outside parties from all liabilities or claims that I might assert in connection with the above-described activities and
3. to waive any right to inspect, approve or receive compensation for any materials or communications, including photographs, videotapes, DVDs, website images or written materials, incorporating photos/images of me/my child/my ward.

Please sign below confirming your choice:

Authorization of Emergency Medical Treatment

In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on the property of the agency, I authorize Blue Sky Acres to secure and retain medical treatment and transportation if needed and release client records upon request to the authorized individual or agency involved in the medical emergency treatment.

Consent Plan

Signing this gives consent to an x-ray, surgery, hospitalization, medication and any treatment procedure deemed "life saving" by the physician. This provision will only be invoked if the person below is unable to be reached.

Non-Consent Plan

I do not give my consent for emergency medical treatment/aid in the case of illness or injury during the process of receiving services, or while being on the property of Blue Sky Acres. 

Please take a minute to familiarize yourself with our Blue Sky Moments Participant & Family Handbook. A link will also be sent to you via email for your reference after submitting this application.

Click here to access the Handbook