Today's Date

First Name *

Last Name *

Phone Number *

Email *

Address Line 1

Address Line 2

City

State/Province Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory

Zip/Postal Code

Country United States of America Canada Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (the Democratic Republic of the) Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czechia Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands [Malvinas] Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (the Democratic People's Republic of) Korea (the Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova (the Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syrian Arab Republic Taiwan (Province of China) Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Türkiye Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara* Yemen Zambia Zimbabwe

Minor Names

Does your child/children have any allergies? If yes, please type below.

Is your child or children currently on any medications?

Emergency Contact Name *

Emergency Contact Phone Number *

Bit of Hope Ranch Hereinafter known as "Ranch” Bit of Hope Ranch Inc. Equine/Ranch Activities, Educational and Therapeutic Program Release of Liability & Assumption of Risk Agreement NOTICE: THIS IS A LEGALLY BINDING AGREEMENT. Bit of Hope Ranch programs include a working equine facility complete with livestock and farm equipment. The Ranch also has a low ropes course, portable low element activities, natural playground, pond and inflatables. These activities can be strenuous and psychologically demanding and require participants to be in good physical condition. Although the programs use trained staff/volunteers and regularly inspect the low ropes course, it is impossible to foresee all possible dangers. Some specific risks the participant may encounter while using the equine activities, therapeutic programs, educational programs, recreational outdoor programs or low ropes course might include, but are not limited to, injury or loss of life from slipping, falling, running, horse bites, horse kicks, and injury from horseback. Participant is aware and understands that participating in Bit of Hope Ranch's programs involves a potential risk of physical injury or loss of life that may not only be from his/her own actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, the condition of the environment, equipment, or areas where the event or activity is being conducted. Participant understands that the programs are physically demanding and potentially dangerous. Therefore, all participants must be free of medical or physical conditions, which might create undue risk to themselves or others who depend on them. If there are any questions about the participant’s ability to participate, please consult with the participant’s physician prior to signing this form or participating in the program. Participant understands that he/she is responsible for behaving in a careful and prudent manner to minimize the risk of injury to themselves or others. Participant understands that this is a voluntary program and that he/she should participate to the extent that they feel appropriate for their own condition and skill level ("challenge by choice"). Participant will not be able to participate if under the influence of drugs or alcohol. *

I hereby authorize Bit of Hope Ranch, the absolute and irrevocable right and permission, in respect of the photographs that have been, or will be taken of the PARTICIPANT or in which the PARTICIPANT may be included with others, to copyright the same, in the name of the Ranch or otherwise, to use, re-use, publish, and republish the same in whole or in part, individually or in conjunction with other photographs, and in conjunction with any printed matter, in any and all media now or hereafter known, and for any purpose whatsoever; and to use my name in connection therewith. I hereby release and discharge the Ranch from any and all claims and demands arising out of or in connection with the use of the photographs, including without limitation any and all claims for libel or invasion of privacy. Note that the privacy of clients is protected and will pictures will not be used without prior permission. *

In the event my Child becomes injured or sick while on the premises of the Ranch, I hereby authorize and consent to the Ranch staff providing first aid, as well as in accord with their best judgment, to summon medical professionals at my expense for the medical treatment of my Child. *

Not to Sue: RATHLEAD LIABILITY RELEASE and BIT OF HOPE RANCH RELEASE: As a PARTICPANT at Bit of Hope Ranch, Inc., I acknowledge the risks and potential for risks of an equine therapeutic, equine recreational, educational and Low Ropes Course related program. However, I feel that the possible benefits to me are greater than the risk assumed. I hereby, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against Rathlead Farms, LLC and Bit of Hope Ranch, Inc. and their members, Board of Directors, volunteers, contract staff and/or employees for any and all injuries and/or losses I may sustain while participating in activities at Bit of Hope Ranch, Inc. I HAVE READ THIS DOCUMENT AND AGREE TO ALL OF ITS TERMS. I UNDERSTAND IT BECOMES A LEGALLY 3 BINDING CONTRACT UPON EXECUTION BY THE RANCH AND THAT IT WAIVES CERTAIN LEGAL RIGHTS OF MINE AND OF MY CHILD INCLUDING BUT NOT LIMITED TO A RELEASE, DISCHARGE, INDEMNIFICATION, PROMISE NOT TO SUE, AND HOLD HARMLESS FROM ALL CLAIMS THAT CAN BE MADE AGAINST THE RANCH AND ITS OWNERS, AGENTS, CONTRACTORS, VOLUNTEERS AND EMPLOYEES. IT IS THE INTENT OF THIS AGREEMENT THAT IT SHALL BE BINDING UPON MYSELF, MY CHILD(REN) AND ANYONE ATTEMPTING TO ACT ON BEHALF OF MY CHILD(REN) AND OUR ESTATES SUCCESSORS AND ASSIGNS. *

How did you hear about us? Social Media Word of Mouth Google Search Other