To register, please complete the online registration form below.



Online Registration



Camper's Name

 Birthday

Age
Home Phone

Street Address

 
City

State

ZIP Code

Father's Name

Place of Work

Father's Phone

Mother's Name

Place of Work

Mother's Phone

Emergency Contact Name

Relationship to Camper

Emergency Contact Phone

Camper Lives With

Name of Child's Doctor

Doctor's Phone
Please list any health or medical concerns
your child may have:


 Please list any routine medications
your child takes:
Date of most recent tetanus immunization:


Please note: If you send medication, it must be in the original container with child's name and directions on the label.


Does your child have allergies?   YES    NO

If YES, please list allergies below

Release of Risk Assumption

I hereby waive and release Haven Of Hope Ministries Inc., and Calvary Baptist Church, Crawfordsville, Indiana, both not-for-profit organizations, its owners, employees and agents, including but not limited to Randall C. Glenn & Kristalina D. Glenn, from liability of any nature, including but not limited to injury, damage or other misfortune resulting from any recreational or educational activity, including, but not limited to horseback riding, grooming, walking or leading, which may take place at the farm, church, or at any other location. I am fully aware that there is an element of risk or injury, damage, or other misfortune associated with these recreational and educational activities. I accept the risk of such activities, and am aware that such activities are for recreation, sport or education, and undertake them voluntarily.


We ask that all friends, family, and guests stay out of all barns, paddocks, tack room and corrals while waiting for a horseback ride, or other related activity. ln consideration of the permission to participate extended to me and for the services rendered by Haven of Hope Ministries, Inc. and Calvary Baptist Church, Crawfordsville, I do hereby for myself, heirs, personal representatives and agents, forever release and discharge my claims, demands, actions, or lawsuits that may occur as a result of negligent, but not reckless, or intentional conduct during my participation.


Name of above participant:


Full name of Legal Guardian if the above visitor/participant is under 18 (please print):



Initials of Legal Guardian: (this serves as your legal digital signature)