Wild West Girls Horse Camp

Camper's Name*

First NameLast Name

Birth Date*

MonthDayYear

Date of Camp*

Date

Age at Time of Camp *

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Parent/Guardian 1*

First NameLast Name

Home Number*

Format: (000) 000-0000.

Alternate Number

Format: (000) 000-0000.

Email*

example@example.com

Relationship *

Parent/Guardian 2

First NameLast Name

Home Number

Format: (000) 000-0000.

Alternate Number

Format: (000) 000-0000.

Email

example@example.com

Relationship

Emergency & Medical Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Special medical or dietary instructions

* PLEASE supply your camper with meal ingredients/ snacks if she has special dietary needs*

Medication list forinsert camper's name*

Please include prescription and over the counter medications.
This list will tell our counselors/office when, how and what to administer to the camper.

No, my child does not have medicationsYes, my child has medications

1. Medication Name

Reason for medication

Dose

2. Medication Name

Reason for medication

Dose

3. Medication Name

Reason for medication

Dose

4. Medication Name

Reason for medication

Dose

5. Medication Name

Reason for medication

Dose

Important Note Regarding Medications:

With the exception of asthma inhalers and EpiPens, no minor (under age 18) may possess any drugs (prescription or non-prescription) on themselves or in their baggage at any time. Upon arrival to camp, all medications must be given to the camp staff who will hold and disburse medications according to prescription directives.
All medication must be in its original container with the attached prescription directives. Medications not in an original container cannot be accepted.
It is requested that all medications belonging to one person be placed into a single zip-lock bag and clearly labeled with the person’s name.

I, the parent/legal guardian of the named camper, hereby give my permission to the staff at Wild West Campground and Corral to dispense to my minor child the medications listed above.

Wild West General Rules for Camp

1. Camper shall conduct herself in a respectful and courteous manner at all times.

2. Camper shall follow rules at all time on or off the premises.

3. Camper will be issued 1 verbal warning after misconduct, if poor behavior persists, camper will lose riding privileges for the next scheduled ride. Written notice will be placed in file.

4. Consistent poor behavior will result in notification of parents and possible expulsion.

5. For safety reasons, no camper will be allowed near horses without proper supervision.

6. No yelling, screaming or running in the presence of horses.

7. Campers will follow counselors instructions without argument.

8. Items in general store are for purchase only. Campers are responsible for payment of items removed from store or lodge.

9. Camper promises to not be a picky eater.

10. Camper will keep their bunkroom area clean and tidy! This rule comes from Health and Human Services and will be enforced at all times!!

11. Camper will keep any and all valuables in a secure place or give them to counselor for lockup. Campers belongings will be accessible at anytime upon request. This especially includes cash!

These rules are in force to insure all campers have the best possible experience while at Wild West Girls Horse Camp!
Let’s all have a great time!!

Wild West Liability Waver

Notice: A person who is engaged for compensation in the rental of equine equipment or tack or in the instruction of a person in riding an equine is not liable for the injury or death of a person involved in the equine activities resulting from the inherent risks of equine activities, as defined in section 895.481 (I)(E) of the Wisconsin statutes.

Liability Release Agreement
I, being of lawful age, desire to participate in horseback riding at Wild West Campground and Corral. I understand that horseback riding involves danger and inherent risk of injury to the rider or passenger should a horse become startled, rear, buck, bite, kick, roll, run or behave in other way which could endanger a rider or passenger and I agree to assume the risk of injury to myself and minors in my care and still desire to participate in these activities even though no amount of preplanning can remove all of the danger to which I am exposing myself and minors in my care.

I will use ordinary care in the use of the said horse and equipment and will not abuse, mistreat, or ride the horse in a reckless manner nor fail to follow instructions given to me. For and in consideration of the opportunity in participate in these horseback riding activities. I forever release, acquit, and discharge Wild West Campground and Corral, and any and all of their employees, agents, and members from any claim or liability that I or any minors in my care, or any of my heirs may incur as a result of my horseback riding activities in and/or around Wild West Campground and Corral or from the rental of the horse or equipment at Wild West Campground and Corral.

Further, I expressingly understand and agree to identify and save harmless Wild West Campground and Corral and all of their employees and agents against any and all further claims or damages incurred by them as a result of any accident or injury which might occur while I or minors in my care are involved in horseback riding activities which may result from any negligence or actions of minors in my care. I understand that by refusing the use of helmets I am refusing critical safety precautions. No oral representations or other agreements not herein expressed have been made to the undersigned and this release constitutes out complete understanding and that the terms of this release are contractual and not a mere recital.

By signing below and listing any participating minors in my care, I indicate that I have read this release agreement, that I understand it, and that I assume full responsibility for my safety and for the safety of participating minors in my care, and ride at my own risk.

Name of child riding*

Camp Date*

Wild West Campground and Corral is not responsible for lost or stolen articles. We STRONGLY discourage brining cell phones, expensive cameras, electronic devices, etc. ABSOLUTELY NO: fireworks, firearms, tobacco, weapons, alcohol, or unprescribed drugs. Possession of these items will result in immediate expulsion! NO EXCEPTIONS!

Parental Authorization

I hereby give permission for my child to attend camp as indicated above. I further certify that this health history is correct as far as I know and the person herein described has permission to engage in all prescribed activities, except as noted. IN CASE OF EMERGENCY, I hereby give permission to the physician selected by the
camp to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child. I also hereby give permission to the camp counselor and/ or other member of the camp staff to inspect the content of any or all of my child' s personal belongings, and to withhold and/ or dispose of any improper or illegal content. NOTE: " Camp Counselor" refers to a ' person in charge of a group of children at camp and does not imply they are licensed to give counsel.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date*

Date

Signature*

Wild West Camp Ground & Corral

Camper Information

Important Note Regarding Medications:

Wild West General Rules for Camp

Wild West Liability Waver