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The Dude Ranchers' Association

America Outdoors

YOUTH PROGRAM INFORMATION AND MEDICAL RELEASE FORM FOR MINORS

CLICK HERE FOR A DOWN-LOADABLE COPY

To help out youth counselors give your child the best possible vacation experience, we would like a little information upfront. This information is the part that we can't really get from your child in the public setting of the program. We will talk with them about what activities they like and what their hopes are for their vacation with us when you arrive.

If you are not the parent or guardian of a child who will be traveling with you, please download a copy for their legal guardian to sign that you can either mail ahead or bring with you.

   

Enter your name and e-mail address.
 

Name

Your e-mail address

 

What is the child's name and date of birth?
 

Child's Name

Date of Birth

 

When will you be arriving?
 

Arrival Date

  
 

Does this child have any special conditions that we should know about? If yes, please be more specific and let us know the best way we can help your child with them.
 

Allergies     

ADD/ADHD

Seizures   

Medications

Other health or behavioral issues we should be aware of

There are times when the children will ask to go to their cabin. For example, they will need to change their swimsuit or grab a sweatshirt. In these instances, do you give permission for your child to travel freely between the lodge and cabins without supervision?

 Yes, my child may go our cabin unsupervised.

 

Other special instructions you would like the youth counselors to have.
 

Message

As a safety consideration, Rock Springs requires the use of equestrian helmets by our guests of youth program age: 12 years old and younger. Helmets are optional, although strongly recommended, for teens and adults. We have helmets available for any guest who did not bring their own.
In the event of an apparent or real emergency, in which treatment or hospitalization of my child may be necessary, after effort to contact me, the undersigned parent or guardian does hereby authorize and appoint Rock Springs Guest Ranch to obtain any medical treatment or hospitalization of the above named child as they believe necessary and proper for the immediate care and welfare of said child. I do further authorize any medical doctor or hospital to render any and all treatment believed necessary and proper for the immediate care and welfare of the above named child. The undersigned shall hold Rock Springs harmless from any and all liability claims as a result of any such medical treatment or hospitalization.
 
Signature:_____________________________________ Date:_____________________

 

 

 
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