Are there ANY allergies, medications, physical restrictions, special instructions, problems or concerns staff should be aware of? Any experience with horses?

Wind Walker Kids Connection Camp 2005

STUDENT MEDICAL AGREEMENT AND RESPONSIBILITY

In the event that my child becomes ill or sustains an injury, I/We hereby authorize the staff of Wind Walker Guest Ranch to act on my behalf and administer first aid for my/our child’s relief. If it is not practical to return my/our child to me/us or to receive my/our instructions for my/our child’s care, consent is hereby given to admit my/our child to any hospital or medical facility. There is an IHC Medical Facility 15 minutes from the ranch. Consent is also given to any licensed physician and or surgeon called or to whom my/our child is taken for treatment by them to administer such treatment, drugs and medicines and to perform such surgical procedures the existing emergency requires for the relief of pain and to preserve my/our child’s life and health. I/We understand that all expenses for such will be at my/our expense. I/We hereby release Wind Walker Guest Ranch and its affiliates, their officers, employees, subsidiaries and agents from all liability for any injury which may result from any such diagnosis and/or treatment. Authorization is also given for such other measures or procedures as may be required.
I/We hereby grant permission for the staff of Wind Walker to authorize the usage of emergency transportation as needed for appropriate emergencies.
I/We hereby permit the staff of Wind Walker Guest Ranch to obtain copies of medical files, immunization records and any other records needed. These copies will be kept on file and will be kept confidential unless needed for illness, medical or emergency situations and may be viewed by any staff of Wind Walker Guest Ranch.
I/we hereby permit and grant permission to use any individual or group photographs/videos showing my/our child in sponsored activities for publicity and brochure purposes. These photographs will be available to all families participating within the program at any time of request.
I/We acknowledge, agree and do hereby release and discharge Wind Walker Guest Ranch and its affiliates, their officers, employees, subsidiaries and agents from all manners of action, causes of action, suits, debts, damages for any personal and or property, or claims and demands of any type or kind whatsoever that may arise on account of any reason or causes, injury or related incident, whatsoever, within the guidelines of services provided by Wind Walker Guest Ranch.
I/We and my/our child understands and agrees that my/our child will abide by the citizenship standards and rules of Wind Walker Guest Ranch, plus cooperative attitude, absolutely NO tobacco, liquor, weapons or illegal drugs being brought, used or possessed during any attendance of Wind Walker Guest Ranch. I/We understand that my/our child may be dismissed for disciplinary reasons and or safety of the other children. Should a child be dismissed by the staff or removed by the parent, no refund is neither made nor equivalent time given. If due to an illness or accident, a child will be offered equivalent future time that was missed during such illness or accident, if such enrollment space is available.
I/We have full legal custody of this child and I/We are authorized to sign this agreement. I/We have fully read and understand the above and agree to be bound by the terms of this document.
Insurance Carrier:
Policy Number:
Allergies/Medical/Additional Concerns:

Signature of Parent/Guardian ________________________Date______________

THE FOLLOWING ITEMS NEED TO BE IN OUR OFFICE FOR YOUR CHILD TO ATTEND CAMP
Registration Form and Medical Release Form.
Deposit of $125 due upon sign up. Unpaid balance must be paid in full 7 days before camp begins. Credit Cards are accepted.

Mail forms and deposit to :
Wind Walker Guest Ranch P.O. Box 7 Spring City, UT. 84662
Any questions or concerns please contact us at 1-888-606-WIND, or email us at Vacation@Windwalker.org

Thanks for your participation. We look forward to another great kids camp year.