Youth programs

Youth & camp
consent

Day camp · youth One per child, per season Signed by parent / guardian

Warning

Under Tennessee law, 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, pursuant to Tennessee Code Annotated, Title 44, Chapter 20.

The child

Child's full name *

Date of birth *

Program *

Session / dates

Riding experience

Child's height & approx. weight

Parent / guardian

Full name *

Relationship to child *

Phone *

Email *We send your copy here.

Home address

Emergency & pickup

A second contact if we can't reach you, and who's allowed to pick up the child.

Backup emergency contact *

Backup contact phone *

People authorized to pick up the child

Medical information

So we can keep your child safe and respond well in an emergency.

Physician name & phone

Health insurance & policy #

Approx. date of last tetanus shot

Current medications

Allergies (food, medication, insect, environmental) *

Medical conditions or anything we should know

Consent, authorization & release

As the parent or legal guardian of the child named above, I agree:

1. Permission to participate. I give permission for my child to take part in equine activities, riding, and horsemanship at Gracewood Acres.

2. Inherent risk & release. I understand equine activities are inherently dangerous and that horses are unpredictable; injury or death can occur despite supervision. On behalf of my child, myself, and our heirs, I release, waive, and hold harmless Gracewood Acres, its owners, staff, and volunteers from all claims arising from my child's participation, including ordinary negligence, to the fullest extent permitted by Tennessee law, and I indemnify them against claims arising from my child's participation. I understand the farm's liability insurance does not cover injury to participants.

3. Authorization to treat. If my child is injured or ill and I cannot be reached, I authorize Gracewood Acres to seek and consent to emergency medical, dental, or surgical treatment by a licensed provider, and I accept financial responsibility for that care.

4. Helmet & instructions. My child will wear a provided, approved riding helmet for all mounted activity and follow staff directions.

5. Governing law. This agreement is governed by Tennessee law; if any part is unenforceable, the rest stands.

I am the parent/legal guardian and I consent to my child's participation and agree to the release above. I authorize emergency medical treatment if I can't be reached, and accept responsibility for its cost. My child will wear a helmet for all mounted activity.

Sign & date

Typing your name and submitting counts as your electronic signature.

Parent / guardian (type full legal name) *

Date *

Signature

Sign with your finger or mouse

★ Goes straight to Gracewood Acres and is filed automatically. Save your own copy on the next screen.

Signed & sent

Your child's all set.

The consent and medical release are with Gracewood Acres and filed for safekeeping. We'll be in touch with program details. Save a copy for your records.

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Youth & campconsent