Camping ReleaseEmergency Medical Release Form (to be filled out for all campers) If emergency medical care is required for:______________________________________ in conjunction with Trinity Stable's camping and instruction, and if normal permission is not available in a timely manner, the undersigned authorizes appropriate medical care as deemed necessary by emergency personnel, a physician, or the medical facility providing treatment. Self/Parent/Legal Guardian:___________________________________________________ Camper Name (if different):_____________________________________ Address:______________________________ _________________________________________ Phone: Home - (____)_______________ Work - (____)_______________ If parent or Legal Guardian is unavailable, Contact:______________________________ Phone:(____)_______________________________ Relationship:____________________________________ Family Physician:________________________________Phone:(____)_____________ Known Allergies:________________________________________________________ Medications and dosage currently being taken (prescription required if given while at Trinity):_________________________________________________________________ _______________________________________________________________________ Camper's Date of Birth:_____________________________________________________ Medical Insurance Company:______________________________________________ Insured Name:_______________________________Policy #:______________________ I have read this release and agree to it : Camper:______________________________________________ Parent/Guardian Signature:______________________________Date:_____________________________ ************************************************************************ As Parent/Legal Guardian of the above named child, I ask that every effort be made to contact me at the time of illness or injury. Additional Comments:______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ______I understand that Trinity Stables, it's employees, and associates are not liable for any accidents, injuries, or thefts to animals, and personal property at the stables. ______I, the undersigned, acknowledge that horseback riding and Camping are an inherently risky activity and hereby release Tom and Michele Adams, and any other person associated with Trinity Stables from ANY liability for injury, damage, or loss to myself, my horses, or my equipment. ______I understand that if rules are habitually broken I (or my child) will be asked to leave the premisis immediately. I understand that no monies will be refunded for early departure. _____I understand that a $1 per minute late pick-up fee will be charged for all children not picked up by 2:15 p.m. daily. _____I understand that, although my child will be supervised at all times, Trinity Stables will not be able to control or watch my child's every move, and hereby release Trinity Stables, it's associates, and employees from all liability from loss or injury to my child, and all personal property brought onto the property located at 5095 Hwy. 416 W., Robards, KY 42452. ______I understand that helmets are mandatory while riding at Trinity Stables. UNDER KENTUCKY LAW, a farm animal activity sponsor, farm animal professional, or other person does not have to eliminate all risks of injury of participation in farm animal activities. There are inherent risks of injury that you voluntarily accept if you participate in farm animal activities. My signature indicates that I have read and agree to the above statements. Camper Signature:___________________________________________________ ______________________________________DATE_______________________ Parent or guardian must sign for rider under the age of 18.
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