Summer Camp Client Application

Registration Date*

Today's Date

Camper Name*

First and Last Name

Camper Date of Birth*

Birthdate

Camper Age During Camp*

Desired Week of Camp*

Height*

Weight*

Address*

Address

Street Address Line 2

CityState

Zip

Phone*

Can we communicate by text?*

YesNo

Email Address*

example@example.com

Ethnicity*

Parent/Legal Guardian Name*

First/Last Name

Phone*

Will you pick up / drop off each day?*

YesNo

If no, please list additional parties responsible for picking up or dropping off your camper please note:

Phone

Referral Source*

How did you learn about Wings of Hope

What are your camp goals? *

Please list 3 things that you would like to experience during camp

Is there anything you would rather not do?

Any fear, phobias, etc.

Describe your horse experience, if any.*

Please include the last time you were around horses, if applicable

Describe your experience grooming, tacking or working independently with a horse, if any:*

Please feel free to share any additional information that may be helpful

Describe your abilities and/or challenges*

Tell us more about you!

Are you a person with a diagnosed disability who will need to complete a medical healthcare statement?*

YesNoI am not sure

If you answered yes or I am not sure to the previous question please list and include details pertaining your disability, diagnosis or challenge.

To help us provide the best support during camp, please indicate if the camper has any special support needs:

Developmental or learning differences (speech or language delays, cognitive differences, sensory sensitivities, processing challenges, or other learning needs)Non-ambulatory or mobility needs (wheelchair, walker, cane, crutches, etc.)Behavioral or attention needs (difficulty sitting still, focusing, regulating emotions, etc.)Other

Will the camper need additional assistance to navigate uneven terrain or participate safely in ground based camp activities? Please note that volunteer support is minimal, so caregivers may need to attend to provide support.*

YesNoI am not sure

If you are a person with disabilities you will need to complete the medical healthcare professional statement form and submit to programs@wingsofhopehorses.org prior to 5/15/26. We will also set up a time prior to the camp for an evaluation at Wings of Hope to get to know you better and how we can best serve you. Please download this form and submit to your physician.

Name *

Primary Emergency Contact Name

Relationship*

Phone*

Name

Relationship

Phone

Allergies*

Please note any health history for consideration in an emergency situation:*

I do or do not consent to and authorize the use and reproduction by Wings of Hope Equitherapy of any and all photographs, video, or any audio-visual materials taken of me or spoken/ written testimonials for promotional material, education activities, social media or any other use for the benefit of Wins of Hope Equitherapy.*

ConsentNon Consent

Participant First Name*

Participant Last Name*

Participant Date of Birth*

Date

Participant Age*

Legal Guardian Full Name*

First and Last Name

I, individually or on behalf of the participant in consideration of the opportunity for the stated participant to participate in or on Wings of Hope Equitherapy ("WOH") property and facilities and/or to work with or ride WOH's horses do hereby release and agree to indemnify, defend, and hold harmless WOH and its board of directors, therapists, aides, volunteers, employees, agents or representatives as set forth below:

I understand and acknowledge that working with and riding a horse involves inherent risks and dangers, which could result in personal injury or death. I/we acknowledge the risks and dangers of working with and riding a horse, and based upon my own analysis, I have made the decision for myself and/or my minor child to participate in the equine services provided by WOH.

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 RISK OF EQUINE ACTIVITIES.

WAIVER AND RELEASE OF LIABILITY I HEREBY EXPRESSLY WAIVE AND RELEASE ANY CLAIM FOR COMPENSATION OR LIABILITY ARISING OUT OF ANY PERSONAL INJURY, DEATH, OR PROPERTY DAMAGE THAT I, MY MINOR CHILD, OR MY WARD MAY SUSTAIN ON WOH'S PROPERTY OR FACILITIES OR IN CONNECTION WITH PARTICIPATING IN ANY ACTIVITIES CONDUCTED BY WOH, REGARDLESS OF WHETHER SUCH PERSONAL INJURY OR DEATH IS CAUSED IN WHOLE OR IN PART BY THE ACTS OR OMISSIONS OR NEGLIGENCE OF WOH OR IT'S BOARD OF DIRECTORS, THERAPISTS, AIDES, VOLUNTEERS, EMPLOYEES, AGENTS OR REPRESENTATIVES "RELEASEES"

INDEMNITY AGREEMENT I FURTHER AGREE TO DEFEND, INDEMNIFY AND HOLD HARMLESS WINGS OF HOPE EQUITHERAPY AND, IT'S BOARD OF DIRECTORS, THERAPISTS, AIDES, VOLUNTEERS, AGENTS AND REPRESENTATIVES ("INDEMNITEES") FROM ANY CLAIM FOR PERSONAL INJURY, DEATH, OR PROPERTY DAMAGE THAT I, MY MINOR CHILD, OR MY WARD MAY SUSTAIN ON WOH'S PROPERTY OR FACILITIES OR IN CONNECTION WITH PARTICIPATING IN ANY ACTIVITIES CONDUCTED BY WOH, REGARDLESS OF WHETHER CAUSED IN WHOLE OR IN PART BY THE ACTS OR OMISSIONS OR NEGLIGENCE OR FAULT OF INDEMNITEES.

I understand that WOH, its Board of Directors, therapists, aides, volunteers, employees, agents, and/or representatives Guarantors, Instructors, Volunteers, and/or Staff members will not be legally liable for any property damage, personal injuries or death that I or, my minor child may sustain in connection with equine activities regardless of any fault or negligence on the part of Indemnitees or Releasees.

I understand that the waiver and release of liability and indemnity agreement extend to any and all activities conducted on WOH's property and facilities or in connection with activities conducted by WOH in which I and/or my child may participate now or in the future.

Signature*

Legal Guardian Full Name*

First/Last Name

Name of Minor Child

Date*

Today's Date

I represent to WOH that I am the parent or legal guardian of the minor child listed above and legally authorized to sign this agreement and bind myself and the minor child to this agreement.

My Products*

Camp Full Payment

$100.00 Quantity
Item subtotal:$0.00

Camp Deposit

$50.00 Quantity
Item subtotal:$0.00

Enter coupon

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please keep for your records.

2026 Summer Camp Application - Ground Based

Emergency Medical Information

Photo/Media Release

Waiver and Release of Liability & Indemnity Agreement

Confidentiality Agreement

Dismissal Agreement

Payment of $100 must be received in full by May 15, 2026