at Vanhoozer Farm 4364 Zion Hill Rd, Weatherford, TX 76088

CAMPER_______________________________________________________ AGE______________

ADDRESS____________________________________CITY_____________________ZIP_____________

HOME PHONE_________________ _____WORK PHONE ___________________ E-MAIL _______________________________________

IN CASE OF EMERGENCY, CONTACT______________________________PH________________

ONE WEEK SESSION (5 DAYS) $200.00 $50.00 deposit required to register

Snacks and drinks provided

8:00 am until 12:00pm

q June 7 - 11

q June 14 - 18 minimum age 7 at all camps

q June 21 - 25

PAYMENT ENCLOSED $_____________ Final payment must be made by the beginning of the first day. No refunds or make-ups will be allowed for non-attendance.

Medical Information Allergies: Bee Sting Poison Ivy Penicillin Other

Type of reaction ____________________________________________________________________

Statement for Treatment

In case of needed emergency medical treatment, I hereby give permission to the physician selected by the Executive Director to secure treatment for my child/ward, as named above.

________________________________________Signature of Parent or Guardian

BOOTS AND HELMETS REQUIRED FOR RIDING - NO EXCEPTIONS

HELMETS SUPPLIED IF NEEDED

LIABILITY RELEASE

________________________________ would like to participate in the Zion Hill Youth Ministries of Parker County, Inc. horse back riding program.

UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), AN EQUINE

PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN

EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES. I

acknowledge the risks and potential for risks of horseback riding and working in and around horses, however, I agree

to assume these risks. I hereby, intending to be legally bound, for myself, my heirs and assigns, executors or

Administrators, waive and release forever all claims for damages against Zion Hill Youth Ministries of Parker County, Inc., Vanhoozer Farm, instructors, aides, volunteers, horse owners and/or Larry and Barbara Vanhoozer, d/b/a Vanhoozer Farm; for any and all injuries and/or losses I/my son//my daughter/ my ward may sustain while participating in Vanhoozer Farm horse back riding program.

Date: ________________ Signature: _________________________________________________________

Parent or Guardian

For more information, please call 817 599-5375 or 817 596-4470 e-mail barbara@vanhoozerfarm.com