CAMP ADAHI RESERVATION Guidelines: 1) 2) 3) 4) 5)
(Non-Scout)
Notes:
C onta ct C ouncil R egistrar for date availability. Reservation is confirmed S ubm it re se rva tion form and agreem ent with a 10% rental deposit plus security deposit. only when this reservation R e se rva tion is for use of any or all facilities listed. A curre ntly ce rtified lifeguard m ust be provided if canoeing or swim m ing. Additional forms form and the deposits have been received by the Girl required for horses. S ubm it full pa ym ent along with insurance certificate and liability waivers at least three weeks Scout Service Center at least four weeks prior to camping prior to ca m p da te. date.
D ate of Application ______________
G roup N am e _______________________________________________
G roup Leader’s N am e ________________________________________ (H ) Telephone ____________________ S treet _____________________________________________________ (W ) Telephone ___________________ C ity __________________________________________________ S tate ______________ Z ip _____________ E m ail _____________________________________________________ (C ell) ___________________________ C am ping D ate: F rom _______________ to _______________ Arrival Tim e: _____________ (P refer weekend arrival between 5pm and 7pm–gate is locked after 8pm). C all C amp R anger at 706-862-2020 if delayed.
Check all facilities to be used:
! Talahi "! Karakondye !" P ooh C orner Cabin units: ! U nalyi "! Ahwenasa Other sleeping areas: !"S taff H ouse ! F ield C am p Other facilities: ! D ining H all ! Kitchen ! S wim m ing P ool ! C anoes Platform tents:
D a m a ge D e posit*
R e nta l Fee*
Rental Fees W eekend U se (F ri. 5 pm to S un. 4 pm )
$2,000.00
+ $500
$
___________
W eek U se (M on. 8 a m to F ri. noon)
$4,000.00
+ $500
$
___________
D ay U se (e xcluding we e ke nd) (8 a m to 4 pm )
$200.00
+ $50
$
___________
U nit U se (per night)
$500.00
+ $75
$
___________
$
___________
Additional Fees $100 S wim m ing P ool (pe r 1
hour pe riod) (form due 2 weeks prior to arrival)
$100 C anoe F ee (form due 2 weeks prior to arrival) ___________ (life jacket & paddle included) *H orse F ee (U se F orm “H orse R e se rva tion”) (form due 3 weeks prior to arrival) (Fees included on horse form) C om m ercial F ood S ervice Adult _____________________________________ P hone N o. _______________ *C ertified C anoe Instructor _________________________________________ P hone N o.
_______________
*C ertified Life G uard ______________________________________________ P hone N o.
_______________
*C ertified Archery Instructor ________________________________________ P hone N o.
_______________
*Send copy of certification card two weeks prior to arrival. Subtotal
$
*LESS DEPOSITS ENCLOSED (10% of rental fee + damage deposit)
$ ___________
R eceipt # _______
Total Fees Due Three Weeks Prior to Camp Date
$ ___________
R eceipt # _______
___________
T he G irl S couts re serve the right to decline any reservation requests. R eferences C am p _____________________________________________________ P hone _________________________ C am p _____________________________________________________ P hone _________________________
SUBMIT TO:
C ouncil R egistrar • G irl S couts • P.O . Box 15969 • C hattanooga, T N 37415-0969 T 423 877 2688 • 800 446 2472 • F 423 877 5587 • info@ m bgsc.org • www.m bgsc.org
GENERAL INFORMATION NO DRUGS, ALCOHOL, WEAPONS OR PETS ALLOWED ON CAMP ADAHI PROPERTY. CAMP ADAHI IS A SMOKE-FREE ENVIRONMENT. ADAHI FACILITIES
The 900-acre Camp Adahi is owned by the Girl Scouts. It serves as a summer resident camp for girls and also for troop camping and program events throughout the year. During the time when the Girl Scouts are not using the camp, it is available for rental to outside groups or organizations.
UNITS
Tent Units – Talahi, Karakondye & P ooh C orner. E ach unit has ten tents on platform s (12’ by 14’). E ach tent sleeps 4. E ach unit sleeps 40. U nits have a play area for gam es and outdoor wash house. Cabin Units – U nalyi and Ahwenesa. T hese units each have five cabins. E ach cabin sleeps 16. E ach unit sleeps 80. C abins have a lounge area and bathroom /shower. Staff House – Kitchen facilities, bathroom /shower, sleeps 10.
RESERVATIONS POLICY R eserva tions a cce pte d be ginning July 1 5 for the com ing year.
Additional Unit Accommodations Talahi and Unalyi – H a ve a troop house (a sse m bly room with fireplace), tables/benches, kitchen with electric refrigerator, and wood cooking stove s.
DEPOSITS T he rental deposit (non-re funda ble ) is 1 0 % of the fe e . T he damage deposit is re funda ble only if ca nce lla tion is m ade in writing a nd re ce ive d two we e ks prior to use or the da m a ge deposit will be re funde d within two we e ks a fte r use of prope rty/fa cilities less any cleaning/damage charges. Additional fees may occur if damages should e xce e d the da m a ge de posit.
PAYMENT F ull paym e nt is due thre e we e ks prior to use .
Karakondye and Ahwenesa – H a ve ope n pa vilion troop shelters, built-in wood cooking stoves/charcoal grills, benches/tables, a nd re frige ra tors. Pooh Corner – H a s a n ope n pa vilion troop she lte r, wood cooking stove , be nche s/ta ble s, a nd re frige ra tor. Outdoor Wash House – H a nd wa shing fa cilitie s, hot showers, flush toilets (water is turned off from N ovember to M arch or according to we a the r; la trine s a re a va ila ble ; wa te r is brought in, but troops ne e d to bring drinking wa te r). Open Fields– Large open fields are available for sports and games. P itch a te nt or bring a ca m pe r (no hookups).
S end de posit/pa ym e nts with re se rva tion form to: Girl Scouts P.O. Box 15969 • Chattanooga, TN 37415-0969
COMMON AREAS Dining Hall –
(200 seat capacity) C onta ins la rge fire place & restroom s.
(P e rsons m ust ha ve e xpe rie nce in com m e rcia l food se rvices).
Kitchen – F urnishe d with com m e rcia l food pre pa ra tion equipm ent. REFUND POLICY R efund re que sts m ust be subm itte d in writing a t le a st four weeks prior to the sche dule d da te .
Pool – Jr. olym pic size with ba thhouse (m ust provide your own certified life guia rd if swim m ing).
Lake – P riva te 5 -a cre la ke for fishing, ca noe ing, picnicing. A cam pfire pit on the ba nks (m ust provide your own ce rtifie d life gua rd if canoeing). N o swim m ing a llowe d.
CAMP ADAHI LICENSE AGREEMENT
(Non-Scout)
T his License Agreem ent is entered into by and be twe e n G irl S couts a nd _ _ _ _ _________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , (the “Lice nse e ” he re ina fte r) this _ ________ day of __________________ _ _ _ _ _ _ _ _ , 2 0 _ _ _ _ . 1.
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Use. Licensee m ay use only those facilitie s de signa te d on the R e se rva tion F orm from ______________ to ______________ _ _ _ _ _ _ _ . Lice nse e will ta ke a ll ne ce ssa ry pre ca utions to pre ve nt its participants from using or entering a ny fa cility which ha s not be e n de signa te d on the R e se rva tion F orm . Licensee understands and fully a gre e s to a bide by the R ule s a nd R e gula tions which a re a ttached hereto and incorporated herein. Lice nse e furthe r a gre e s to a bide by a ll a pplica ble la ws, sta tutes, codes and regulations in its use of C a m p Ada hi. Lice nse e sha ll fully inform G irl S couts of its proposed use of C am p Adahi prior to a rriva l. Lice nse e m a y be a ske d to le a ve C a m p Ada hi without refund for any violation of any of the te rm s a nd conditions of this Lice nse Agre e m e nt or a ny viola tion of the R ules and R egulations, at the reque st of G irl S couts or its re pre se nta tive . Counselors. Licensee shall provide proper, adult supervisions for the participants. Licensee shall provide at least one (1) C ounselor for every ten (10) participants. E ach C ounselor will be at least eighteen (18) years of age. At least one (1) counselor shall be at least twenty-one (21) years of age and trained in C P R and first aid. A first aid kit must be supplied by user. The dates of the C P R training and first aid training for this designated C ounselor MUST be stated clearly on the attached R ider. All activities in the unit will be supervised by the C ounselors. Lifeguards. Licensee shall provide a prope rly tra ine d life gua rd a t a ll tim e s tha t its pa rticipa nts a re using the pool or canoeing in the lake. E ach life gua rd sha ll posse ss a R e d C ross Life gua rd C e rtifica te or other training certificate acceptable to G irl S couts. Licensee shall take all necessary precautions to ensure that no one uses the pool or canoes in the lake unless a lifeguard is present and supervising the pool and/or lake. Prohibited Areas. Licensee shall take a ll ne ce ssa ry pre ca utions to e nsure tha t is pa rticipa nts a void a ny areas which it has not designated on the R e se rva tion F orm . Lice nse e will pre ve nt its pa rticipa nts from entering the equine area and will preve nt its pa rticipa nts from swim m ing in the la ke . Rules and Regulations. Licensee shall ta ke a ll ne ce ssa ry pre ca utions to e nsure tha t the participa nts follow all of the R ules and R egulations, which a re a tta che d he re to a nd incorpora te d he re in. List of Participants. T he participants liste d on the a tta che d R ide r sha ll be the only pa rticipants a t C a m p Adahi. Licensee represents that it has obta ine d a pa re nta l re le a se , wa ive r a nd inde m nity a gre e m e nt (in a form acceptable to the G irl S couts) for e a ch pa rticipa nt unde r the a ge of e ighte e n (1 8 ). Lice nse e further represents that it has obtained a re le a se , wa ive r a nd inde m nity a gre e m e nt (in a form a cce pta ble to the G irl S couts) for each participant ove r the a ge of e ighte e n (1 8 ). Lice nse e furthe r re pre se nts tha t it has obtaine d insurance and all known a lle rgie s or he a lth conditions for e a ch pa rticipa nt. F or e a ch participant who is under the age of 18 a nd not a ccom pa nie d by the ir pa re nt or gua rdia n, Lice nse e sha ll obtain a signed form granting perm ission to se e k e m e rge ncy tre a tm e nt.
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Indemnity. Licensee shall indem nify a nd hold ha rm le ss the G irl S couts, including its successors a nd assigns, agents and em ployees from a ny a nd a ll lia bilitie s, a ctions, cla im s, including ne glige nce , a rising from any accident, injury or death to a ny pa rticipa nt or a ny othe r pe rson who is in a ny wa y re la te d to the License e and who participants in a ny functions a t C a m p Ada hi. License Revocable. N otwithstanding any othe r provision of this Lice nse Agre e m e nt, the Lice nse e unde rstands and agrees that this License Agre e m e nt is re voca ble a t the sole , a bsolute a nd unfe tte re d discre tion of the G irl S couts at any tim e without notice , provide d howe ve r, tha t P a ra gra ph 7 of this Lice nse Agreem ent shall survive term ination. Condition of the Property. Licensee sha ll not le a ve a ny wa ste on the fa cility, sha ll not cut down or destroy in a ny way any of the facilities or the la ndsca ping. Lice nse e sha ll be lia ble for a ny da m a ge done to the facility or the im provem ents the re on a nd a ny pe rsons e nte ring onto the fa cility pursua nt to this License Agreem ent. Insurance Requirements. P rior to the use of the pre m ise s indica te d a bove , Lice nse e sha ll provide G irl S couts with the following evidence of insura nce : a) C ertificate of com m ercial general lia bility insura nce , including contra ctua l lia bility for bodily injury and property dam age in an am ount not le ss tha n $ 1 ,0 0 0 ,0 0 0 com bine d single lim it a nd na m ing the G irl S couts as an additional insure d. b) If Licensee intends to use vehicles on the C a m p Ada hi pre m ise s, a ce rtifica te of insura nce is needed for autom obile liability for owne d, non-owne d, a nd hire d ca rs with a m inim um lim it of $1,000,000 com bined single lim it for bodily injury a nd prope rty da m a ge . c) If Licensee em ploys staff, certification tha t worke rs’ com pe nsa tion a nd e m ploye rs’ lia bility a re covered with this insurance. d) T he insurance should be with a com pa ny whose fina ncia l soundne ss ca n be ve rifie d by a na tiona l rating service such as A.M . Best, S ta nda rd a nd P oors, or D un & Bra dstre e t.
THE PERSON SIGNING THIS LICENSE AGREEMENT ON BEHALF OF THE LICENSEE WARRANTS AND REPRESENTS THAT HE OR SHE IS DULY AUTHORIZED TO SIGN THIS AGREEMENT ON BEHALF OF THE LICENSEE AND IS DULY AUTHORIZED TO BIND THE LICENSEE TO THE TERMS AND CONDITIONS HEREIN AND THE ATTACHED RULES AND REGULATIONS
LICENSEE By: _ ________________________________ _ _ _ _ _ _ _ _ _ _ P rint N am e: __________________________ _ _ _ _ _ _ _ _ _ _
RULES AND REGULATIONS OF CAMP ADAHI (Non-Scout) •
C ars m ust be parked in the guest parking lot.
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S m oking is perm itted only in areas specifica lly de signa te d by the C a m p Ada hi D ire ctor.
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Licensee shall leave the perm itted facilitie s of C a m p Ada hi (the “P re m ise s” he re ina fte r) in good condition for the next occupants. T he R anger will de cide , in his or he r sole discre tion, whe the r the P re m ise s a re in good condition at check-out.
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P ossession, sale or use of controlled substa nce s or posse ssion, consum ption, or sa le of intoxica ting liquors by any person or group is not perm itte d a t a ny tim e on the P re m ise s.
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N o pets or anim als shall be allowed on the pre m ise s without prior a pprova l by the C ouncil a nd only unde r e xtraordinary circum stances.
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T he Leader of the Licensee will check in a t the R a nge r’s H ouse upon a rriva l a nd de pa rture . Lice nse e sha ll pay the balance of the fee prior to arrival.
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D eparture tim e will be at or before 4 p.m .
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A person 21 years of age or older represe nting the group will be on the P re m ise s a t a ll tim e s.
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Licensee will properly supervise all participa nts to pre ve nt da m a ge or loss to a ny pa rt of the P re m ise s.
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C am p Adahi does not provide m edical supe rvision, tre a tm e nt, m a inte na nce , or dispe nsing of m e dica tions for cam pers. T hese responsibilities belong to the Lice nse e : Lice nse e will provide a n a dult a t le a st 2 1 ye a rs of age and who possesses at least a certifica te of first a id a nd C P R tra ining. Lice nse e will bring its own first a id supplies and equipm ent. E m ergency tre a tm e nt is a va ila ble through loca l e m e rge ncy re sponse groups. Licensee will furnish any non-em ergency tra nsporta tion.
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N o hazardous or m edical waste shall be le ft by the Lice nse e .
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Licensee will ensure that participants are in physica l condition to pa rticipa te in stre nuous physica l a ctivitie s if such activities are planned.
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N either the G irl S couts nor C am p Adahi provide s m e a ls. If Lice nse e is pre pa ring its own food, it a ssum e s a ll responsibility for any foods prepared, a nd for a ll a ctivitie s incide nt to the ir pre pa ra tions, a nd sha ll hold the G irl S couts and C am p Adahi harm less from a ny a nd a ll lia bility the re in. Lice nse e sha ll a bide by the directions provided in the Kitchen M anual for C a m p Ada hi.
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N o outdoor fires m ay be built without prior pe rm ission a nd only in de signa te d fire rings.
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Licensee shall conduct a fire drill before re tiring the first da y on the site .
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Licensee shall abide by all applicable laws, code s a nd re gula tions in its use of the P re m ise s. Lice nse e is strictly prohibited from hunting, or using fire works, fire a rm s, a m m unition, una uthorize d we a pons or e xplosives on the P rem ises. Licensee is strictly prohibite d from using ga soline , fla m m a ble s, poisonous substances, and hand and power tools.
The Girl Scouts reserve the right to terminate this agreement for the use of its facility by the named organization at its discretion for violation of any of the above rules.
CAMP ADAHI TROOP HORSERESERVATION RESERVATION CAMPADAHI ADAHIHORSE CAMP Guidelines: S ubm it request to C ouncil R egistrar. T he troop leader will be notified if space is not available and a new date can be scheduled. M ust com plete “P arental P erm ission & Agreem ent” and “Agreem ent to P articipate” form s for each participant and give to instructor at tim e of participation. Notes: Your reservation is confirm ed only when this reservation form and the m oney have been received by the G irl S cout S ervice C enter at least three weeks prior to riding date. H orses are reserved only when an equestrian director is available. D ate of Application __________________________ D ate of P rogram _________________________________ Troop # ____________ P rogram Level _______________ S ervice U nit _______________________________ Troop Leader’s N am e ________________________________________ E m ail ___________________________ S treet ___________________________________________ C ity _________________ S tate _____ Z ip ________ Telephone (H ) _________________________ (W ) _______________________ (C ) ______________________ See Horse Program sheet for girl fees based on # of girls participating.
“P e t A P ony”
_____ # G irls @
“Intro to H orses”
_____ # G irls @
“R iding S kills” “Trail R iding”
SUBMIT TO:
#"$10 # $15 # $20 per girl = $ _______
#"$10 # $15 # $20 per girl = $ _______ _____ # G irls @ #"$10 # $15 # $20 per girl = $ _______ _____ # G irls @ #"$15 # $20 # $25 per girl = $ _______
C ouncil R egistrar • G irl S couts
• C hattanooga, T N 37415-0969 T 423 877 2688 E xt. 233 • 800 446 2472 • F 423 877 5587 • info@ m bgsc.org P.O . Box 1 5 9 6 9 (1 9 3 6 D a yton Blvd.)
CAMP ADAHI TROOP HORSERESERVATION RESERVATION CAMPADAHI ADAHIHORSE CAMP Guidelines: S ubm it request to C ouncil R egistrar. T he troop leader will be notified if space is not available and a new date
can be scheduled. M ust com plete “P arental P erm ission & Agreem ent” and “Agreem ent to P articipate” form s for each participant and give to instructor at tim e of participation. Notes: Your reservation is confirm ed only when this reservation form and the m oney have been received by the G irl S cout S ervice C enter at least three weeks prior to riding date. H orses are reserved only when an equestrian director is available. D ate of Application __________________________ D ate of P rogram _________________________________ Troop # ____________ P rogram Level _______________ S ervice U nit _______________________________ Troop Leader’s N am e ________________________________________ E m ail ___________________________ S treet ___________________________________________ C ity _________________ S tate _____ Z ip ________ Telephone (H ) _________________________ (W ) _______________________ (C ) ______________________ See Horse Program sheet for girl fees based on # of girls participating.
“R iding S kills”
#"$10 # $15 # $20 per girl = $ _______ _____ # G irls @ #"$10 # $15 # $20 per girl = $ _______ _____ # G irls @ #"$10 # $15 # $20 per girl = $ _______
“Trail R iding”
_____ # G irls @
“P et A P ony” “Intro to H orses”
SUBMIT TO:
_____ # G irls @
#"$15 # $20 # $25 per girl = $ _______
C ouncil R egistrar • G irl S couts
• C hattanooga, T N 37415-0969 T 423 877 2688 E xt. 233 • 800 446 2472 • F 423 877 5587 • info@ m bgsc.org P.O . Box 1 5 9 6 9 (1 9 3 6 D a yton Blvd.)
Camp Adahi
PROGRAMS
Horse Programs Horses are only available if an equestrian director is available.
TO ALL PARTICIPANTS T ha nk you for participating in C am p Adahi’s H orse P rogra m s. To a ssure that your experience is as enjoyable a s possible , ple a se follow these rules: RULES $ G irls m ust com e to the barn at appointed tim e . Any de la ys will re sult in a shorter lesson for your troop. $ G irls m ust wear long pants (baggy pants are not recommended). $ D angling jewelry and large hoop earrings a re not pe rm itte d.
“Pet A Pony” Kindergarten & 1st Grades M eet the horses of Adahi! R eceive a barn tour, learn about the kinds of horses at C am p Adahi, and learn to approach a horse, followed by a short led ride.
$20 per girl for 3 girls or less. $15 per girl for 4-6 girls. $10 per girl for 7-15 girls.
“Introduction to Horses” 1st Grade & up S tart to feel com fortable around horses as you learn to approach and groom a horse, m ount and dism ount, and lead. A short ring ride concludes the lesson. S om e girls m ay need to be led.
$20 per girl for 3 girls or less. $15 per girl for 4-6 girls. $10 per girl for 7-15 girls.
$ S hoes m ust be sturdy with 1” straight hee ls. N o te nnis shoe s or hiking boots allowed. (W e have a few pairs of boots for those who have none.) “Riding Skills” $ H elm ets will be furnished at cam p and m ust be worn in a ll riding sessions. You m ay bring your own he lm e t if it is “S E I” a pproved. $ P erm ission slips m ust accom pany girls to the ba rn. G irls forgetting their slips will not be allowed to ride . $ N o “Tagalongs” perm itted in the barn area s. $ G roups waiting their turn m ust wait outside of ba rn a nd ring a reas and m ust be supervised. $ M axim um num bers are firm . S om e troops m a y ne e d two or m ore tim e slots to accom m odate the whole troop. Also, the num ber of girls riding at the sam e tim e will de pe nd on he a lth a nd suitability of horses. $ Maximum weight to ride horses is 225 lbs. $ All program s are one hour in length. G irls will be te ste d on prerequisite skills before being allowed to proce e d to the ne xt le vel. In case of inclem ent weather, activitie s using horse s in the barn will be substituted. $ All fees m ust be paid prior to ride. $ Troops m ust be on tim e. M oney is nonrefunda ble . Tim e will be m ade up only if enough tim e is available. $"T he E questrian D irector will call prior to sche dule d da te with tim e slot.
2nd Grade & up C over horse safety, m ounting, dism ounting, and reining. Try your skills in a ring ride as you learn to walk, circle, and turn about. S kill assessm ent will be m ade by the E questrian D irector and program will be adapted to m eet skill level.
$20 per girl for 3 girls or less. $15 per girl for 4-6 girls. $10 per girl for 7-8 girls.
“Trail Riding” 5th Grade & up A ring test, showing the ability to control your horse at a walk and trot and to keep one horse length between horses, m ust be com pleted before being allowed to take a horse on a trail ride. You must know basic skills— recom m ended to take Interm ediate R iding S kills prior to this class.
$25 per girl for 3 girls or less. $20 per girl for 4-6 girls. $15 per girl for 7-8 girls.
RESERVATIONS Council Registrar
423-877-2688 800-446-2472
[email protected]
CAMP ADAHI HORSE RESERVATION
Parental Permission and Agreement (Non-Scout) One form per rider must be given to instructor at time of participation.
I, ______________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ give pe rm ission for m y child _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ______ to participate in a horseba ck riding a ctivity a t C a m p Ada hi. T his a ctivity will be ta ught by a tra ine d instructor. I understand that the a ctivity of riding or working with horse s involve s num e rous risks of injury including loss of control, collisions or obstacle s. I unde rsta nd tha t a n a nim a l, irre spe ctive of its tra ining a nd usua l pa st be ha viors and characteristics, m ay act or re a ct unpre dicta bly a t tim e s, ba se d upon instinct or fright. T his is a n inhe re nt risk to be assum ed by each participant in the a ctivity. I a gre e to a ssum e the risk of injury or de a th ca use d by pa rticipa tion in a horseback riding activity at C am p Ada hi. M y child is in good he a lth a nd good physica l condition a nd ha s no he a lth or a lle rgic conditions tha t organizers m ay be aware of, except as liste d be low. _______________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ _______________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ _______________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ I am aware that the G irl S cout make films and photographs at activities such as this event. They "!"may !"may not use pictures of my child and/or audio recordings of his/her voice. In the event of an em e rge ncy, m y child ""!"m a y !"m a y not be tre a te d by a ny doctor on duty a t a clinic or hospital near the activity site. If I ca nnot be re a che d in a n e m e rge ncy, the following pe rson is a uthorize d to a ct on m y behalf: N am e ___________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Addre ss _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __________ P hone __________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ R e la tionship _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __________ I have read the inform a tion supplie d by the G irl S couts, a nd I ha ve be e n give n the opportunity to a sk questions about the activities involve d in this e ve nt. I re cognize tha t a ccide nts do occur a nd tha t ce rta in risks a nd da ngers exist in all activities. T hese risks include , a m ong othe r things, loss or da m a ge to pe rsona l prope rty, injury or fa ta lity due to participation in activities, a ccide nt or illne ss in re m ote pla ce s, a nd a ccide nts while tra ve ling to a nd from a ctivity sites. In consideration of m y child’s a tte nda nce a t this e ve nt, I a ssum e a ll the risks inhe re nt in m y child a tte nding this event and participating in the a ctivitie s a nd re le a se a ll cla im s, including ne glige nce , a rising out of this e ve nt and I hereby indem nify and hold ha rm le ss the G irl S couts, its succe ssors a nd a ssigns, a nd a ge nts a nd e m ploye e s from any liabilities, actions, and cla im s, including ne glige nce a rising from a ny a ccide nt or injury. T his contract shall be le ga lly binding upon m e , m y he irs, m y e sta te , a ssigns, le ga l gua rdia ns a nd m y personal representatives. I have carefully rea d this a gre e m e nt a nd fully unde rsta nd its conte nts. I a m a wa re tha t I a m re le a sing certain legal rights that I otherwise m a y ha ve a nd e nte r into this contra ct on be ha lf of m yse lf a nd/or m y fa m ily of m y own free will. By signing this relea se , I a cknowle dge tha t I ha ve re a d the fore going a nd unde rsta nd its conte nts. (S ignature of both parents required).
THIS IS A RELEASE OF LIABILITY. DO NOT SIGN THIS RELEASE IF YOU DO NOT UNDERSTAND OR DO NOT AGREE WITH ITS TERMS.
S ignature of P arent or G uardian
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S ignature of P arent or G uardian
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CAMP ADAHI HORSE RESERVATION Agreement to Participate
One form per rider must be given to instructor at time of participation. I understand that my attitude and behavior are critical while participating in horseback riding, an activity of the G irl S couts. For the good of the activity and my fellow troop members, I agree to do the following: 1. I am awa re tha t a ccide nts or injury m a y occur while pa rticipa ting in this e ve nt. I re cognize the importance of following instructions and will obey leaders’ and counselors’ instructions while attending this activity. 2. I will use a ll re quire d sa fe ty e quipm e nt a nd follow sa fe ty rule s a nd proce dure s. 3. I will handle a ll e quipm e nt provide d for m y use with ca re . I unde rsta nd tha t I a m re sponsible for their loss or da m a ge due to m y ne gle ct. 4. I will be se nsitive to the ne e ds of e a ch group m e m be r a nd re spe ct othe r pe ople , pla ce s, and property with which I com e in conta ct. 5. I will be responsible for any personal belongings and equipm ent. In the event of any loss or dam age to m y equipm e nt, I will not hold the G irl S couts re sponsible for m y ne gle ct. 6. I will not use toba cco, a lcohol, or drugs, a nd I unde rsta nd a ny such use will re sult in m y e xpulsion from the a ctivity. 7. I will handle m y sha re of re sponsibilitie s. I understand that if I do not a bide by the a bove prom ise s, I m a y be e xpe lle d from the a ctivity a nd se nt hom e, at the expense of m y pa re nts. S igna ture of P a rticipa nt
D a te I have read the foregoing sta te m e nt a nd a gre e with the a bove re sponsibilitie s of m y child. I give m y child perm ission to attend this a ctivity unde r the a bove conside ra tions. (S igna ture of both pa re nts re quire d.)
Warning U nder Te nne sse e La w, a n e quine profe ssiona l is not liable for an injury to or the de a th of a pa rticipa nt in e quine a ctivities re sulting from the inhe re nt risks of e quine a ctivities, pursua nt to Te nne sse e C ode Annota te d, Title 4 4 , C ha pter 794.
S igna ture of P a re nt or G ua rdia n
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Te le phone
Warning U nder G e orgia La w, a n e quine a ctivity sponsor or e quine professiona l is not lia ble for a n injury to or the de a th re sulting from the inhe re nt risks of e quine a ctivitie s pursua nt to C hapte r 1 2 of Title 4 of the O fficia l C ode of G e orgia Annotated.
S igna ture of P a re nt or G ua rdia n
Te le phone
Warning U nder V irginia La w, a n e quine a ctivity sponsor or e quine professiona l sha ll not be lia ble for a n injury to or de a th of a participa nt re sulting from the intrinsic da nge rs of e quine activitie s pursua nt to C ha pte r 3 .1 -7 9 6 -1 3 2 of the O fficial C ode of V irginia C ode Annota te d.
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