If your first choice is filled and you would like to be considered for alternate sessions please indicate below
PHOTO VIDEO & PUBLICITY RELEASE
High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities.
By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively "image"), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.
(Name) would like to participate in the High Hopes
Therapeutic Riding Inc. program. I acknowledge the risks and potential for risks of horseback riding and related equine activities,
including grievous bodily harm. However, I feel that the possible benefits to myself/my child/my ward are greater than the
risk assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors, and administrators, waive
and release forever all claims for damages against High Hopes Therapeutic Riding, Inc., its Board of Directors, Instructors,
Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I/my child/my ward may sustain while
participating in the Program from whatever cause including but not limited to the negligence of these released parties.
The undersigned acknowledges that he/she has read this Registration and Release Form in its entirety; that he/she
understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.
Authorization for Emergency Medical Treatment for Camp
(to be invoked in the event that your Emergency Contact cannot be reached.)
If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.
Potassium Iodide (KI) Fact Sheet and Permission
The State of Connecticut is making Potassium Iodide tablets (KI) available to child care facilities and youth camps within the 10-mile emergency planning zone around Millstone Power Station in Waterford, CT. KI is a form of iodine. It helps to protect the thyroid gland when there is a chance that you might be exposed to a harmful amount of radioactive iodine. In the rare event of a nuclear emergency, your child care provider will be directed when to administer KI through the Emergency Alert System (EAS). Children in child care and youth camps are of the age most likely to suffer the effects of radioactive iodine. Your childcare program or youth camp must obtain your written consent in order to administer KI pills to your child/children. Please remember that the administration of KI to your child under these emergency conditions is voluntary.
• Your child should not take Potassium Iodide if he/she is allergic to iodine.
• Your child should not take Potassium Iodide if he/she has chronic hives.
• Although a single tablet of KI should be tolerated by most people, some (particularly adults), with a number of rare diseases and conditions should discuss this issue with their physicians. These conditions include:
o Hypocomplementemic vasculitis, possibly as a component of lupus or chronic hives,
o Autoimmune thyroid disease, such as Graves disease.
• Potential side Effects: Please consult with your pediatrician if your child experiences any of these side effects:
o Minor upset stomach
Summer Camp Participation Policies
You may download a copy of our Summer Camp participation policy here:
Please note: Application forms are required on an annual basis, and applications cannot be taken over the telephone.
We suggest campers wear long pants and boots with a heel. We will provide an ASTM/SEI certified helmet that the child MUST wear at all times when working with the horses. Campers should bring lunch, pants, shorts, water bottle, etc. each day.
Payment & Cancellation Policy
Camp sessions are prepaid and secure your camper’s placement in your desired week of camp. The payment for a camp session must be made in full at least one month prior to camp.
Cancellation policy: If a camper cancels, their tuition minus a $50 processing fee will be returned only if another camper fills the spot.
High Hopes Summer Camp is licensed through the State of Connecticut which required written authorization from a physician and a parent or legal guardian to campers needing medication during camp hours. This include but it not limited to epi-pens, inhaler, oral and topical medication.
At your request we will provide a copy of our medication administration policy
and form or refer you to our website to download a copy.
Thank you for completing our Summer Camp 2018 Registration! You will now be redirected back to the summer camp page. Please download the physician's form and the payment form. Have your physician complete and return the physician's form. Please send the payment form to High Hopes together with your check.