Camper Profile : Menagerie Farm

Please fill out this Camper Profile to register for our Summer Day Camps

Camper Information

Child’s Name: Birthday: Age: Gender: T-Shirt Size:

Parent/Guardian Information

Parent’s Name: Address: City: State: Zip: Home Phone: Email:

Camp Details

Which week or weeks will your child attend Camp? Full Day or Half Day?
Full DayHalf Day

Parent Employment Info

Mother’s Place of Employment Phone: Mother’s Cell Phone: Father’s Place of Employment Phone: Father’s Cell Phone:

Emergency + Additional Info

Emergency Contact and Phone Number: Are you carpooling with another camper? List Names: School Attended:

Pick up Policy

Notification in writing must be given if someone other than parent is picking up.

Special Needs or Comments

Please list if your child has any type of allergies or has any special needs Menagerie Farms may need to know.

Parent/Guardian Waiver for Minors

I hereby assume all of the risks of participating in this activity or event, including but not limited to any risks that may arise from negligence or carelessness on the part of Menagerie Farms, LLC, from dangerous or defective equipment or property owned, maintained or controlled by them.

I waive, release and discharge from any and all liability, including but not limited to liability arising from the negligence or fault of Menagerie Farms, LLC, or its employees or agents, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur.

I indemnify and hold harmless Menagerie Farms, LLC, from any and all liabilities, claims, suits or actions for damages as a result of participating in this activity or event.

I understand that this release binds my heirs, successors, and assigns.
I have read this document and fully understand its content. I am aware that this is a release of liability.

The undersigned parent/guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child's/ward's participation in this activity or event, and has agreed individually and on behalf of the child/ward to the terms of the accident waiver and release of liability set forth herein.

Full name of Parent/Guardian (serves as signature):

Release and Hold Harmless Agreement

Whereas, the undersigned desires to participate in equine and all activities offered at Menagerie Farm LLC, and fully understands and agrees that in participating in equine and all activities and while attending camp sessions, there is a possibility of accidental or physical injury, property damage or loss. Therefore, for good consideration the undersigned agrees to assume full responsibility for risk of such injury and hereby releases, discharges and acquits Menagerie Farm LLC, Danya Welch, Mack Williamson, Waymon H. Welch, Donna A. Welch, Dawn Kinard and William Kinard, Donna Welch Family LLC, Shea Road LLC any landowners, instructors, employees, volunteers and all individually and in all capacities which they may hold, their heirs, successors, assigns and personal representatives, from any personal injury, property damage or loss of any kind arising from any act or occurrence surrounding and or connected with any of the above listed.

Warning: Under Tennessee law an equine professional is not liable for any injury or the death of a participant in equine activities resulting from the inherent risk of equine activities, pursuant to Tennessee code annotated, Title 44, Chapter 20.(Acts 1992, ch. 974, s6)

I have read the Release and Hold Harmless Agreement and I fully understand its content. I am aware this is a release of liability. The undersigned parent/guardian does hereby represent that he/she is in fact acting in such capacity, has consented to his/her child participation in these activities or events and has agreed individually and on behalf of the child to the terms of the accident waiver and release of liability set forth herein.

This Release and hold harmless agreement is to be signed by all parties working, volunteering and participating in equine, water activities and all activities offered by Menagerie Farm LLC.

All employees and volunteers are aware of safety rules, emergency contacts, first aid and how to proceed, location of all exit strategies and location of fire extinguishers.

All employees and volunteers are made aware of camper profiles and parent contact information in case of emergency.