Hinchinbrook Sensory Camp

Family Name:

Parents Names:

Number of children:

Child One Name:

Child One Date of Birth (DOB):

Child Two Name:

Child Two DOB:

Child Three Name:

Child Three DOB:

Child Four Name:

Child Four DOB:

Complete civic/mailing address:

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PLEASE READ. BY CLICKING "SEND", YOU AGREE TO THE FOLLOWING

We would like to participate in the Hinchinbrook Farm Society program. I acknowledge the risks, and potential for risk, of horseback riding, driving, and all activities at the farm or at farm event. However, I feel that the possible benefits to myself / my son / my daughter / my ward are greater than the risk assumed. I hereby, intending to be legally bound, for myself, my heirs and my assigns, executors or administrators, waive and release forever all claims for damages against Hinchinbrook Farm, its Board of Directors, Instructors, Therapists, Aids, Volunteers and or Employees for any and all injuries and/or losses I / my son/ my daughter/ my ward may sustain while participating in Hinchinbrook Farm Activities.
I agree