Summer Camp Registration & Consent Packet

This Summer Camp Registration & Consent Packet ("Packet") enrolls the camper identified below ("Camper") in the horse camp operated by [FACILITY NAME], located at [FACILITY ADDRESS] ("Facility"), and records the consents the Facility requires before the Camper may attend. It is completed and signed by the Camper's parent or legal guardian ("Parent"). By signing, the Parent enrolls the Camper for the session(s) selected and agrees to each consent and policy below.

1. Camper Information

Camper Full Name: ______________________________

Date of Birth: ______________________________

Age at Start of Camp: ______________________________

Camp Session(s) / Dates Enrolled: ______________________________

Home Address: ______________________________

T-Shirt Size (if provided): ______________________________

2. Parent/Guardian and Emergency Contacts

Parent/Guardian Full Name: ______________________________

Relationship to Camper: ______________________________

Cell Phone (reachable during camp hours): ______________________________

Email: ______________________________

Second Emergency Contact and Phone: ______________________________

Persons Authorized to Pick Up the Camper: ______________________________

The Facility will release the Camper at the end of each day only to the Parent or to a person listed above. A person picking up the Camper may be asked for photo identification. The Parent will notify the Facility in writing of any change to the authorized pick-up list.

3. Medical History and Allergies

The Parent will complete the following so the Facility can keep the Camper safe and respond appropriately in an emergency. The Parent represents that this information is accurate and complete and will update it if anything changes before or during camp.

Known Allergies (food, insect, medication, environmental) and Reactions: ______________________________

Chronic Conditions (e.g., asthma, diabetes, seizures, ADHD): ______________________________

Current Medications and Dosages: ______________________________

Dietary Restrictions: ______________________________

Physical Limitations or Recent Injuries: ______________________________

Date of Last Tetanus Vaccination: ______________________________

Health Insurance Carrier and Policy Number: ______________________________

Physician Name and Phone: ______________________________

4. Medication Administration Consent

Complete only if the Camper needs medication during camp hours. The Parent authorizes designated Facility staff to store and administer, or to assist the Camper in taking, the medication(s) listed below according to the written instructions the Parent provides. All medication must arrive in its original, labeled container. The Parent authorizes staff to administer emergency medication — such as an inhaler or an epinephrine auto-injector — as prescribed. The Facility's staff are not medical professionals, and the Parent accepts the ordinary risks of having staff assist with medication as described here.

Medication Name: ______________________________

Dose and Time(s) to Administer: ______________________________

Special Instructions: ______________________________

Emergency Medication and Location Kept: ______________________________