After clicking submit, be sure to scroll back down and sign electronically. An email should be sent after you sign.

ROCK Participant Camp Application

Camp Overview

Camp Overview

Participant Registration - Please input information for the actual participant here.

Participant Registration


Contact information

In the event of an emergency, contact:

Page 3

Participant information

 Consent Forms

ROCK Social Media Policy:
ROCK controls what is posted on the ROCK Facebook and other ROCK social media outlets.  Only those who singed Photo Releases may have photographs posted.  Participant and families are asked verbal permission prior to posting.  No participant names are posted. If taking pictures/videos for personal use, respect the privacy of other riders by not posting photo/videos on social media that include other participants.

ROCK Authorization for Emergency Medical Treatment

Read both and select one below

ROCK Confidentiality Policy:
I understand that all information, both written and verbal, regarding participants at ROCK, Ride On Center for Kids, and confidential business matters shall be held in strict confidence at all times except as needed with the facilitation for therapy and/or business purposes.

I understand that a breach of confidentiality is grounds for dismissal and may also result in legal prosecution. 

Liability Release:
I or my child would like to participate in the ROCK program.  I acknowledge the risks and potential risks of horseback riding.  However, I feel that the possible benefits to myself/son/daughter/ward are greater than the risk assumed.  I hereby intending to be legally bound, for myself, my heirs, and assigns, executors or administrators, waive and release forever all claims for damages against ROCK, its Board of Directors, Instructors, Therapist, Aides, Horse Owners, Volunteers and/or Employees for any and all injuries and/or losses I/my son/daughter/ward my sustain while participating in ROCK programs.  WARNING- Under Texas law(chapter 87, Civil Practice and Remedies Code), an equine professional is not liable for an injury or the death of a participant in equine activities result in from the inherent risks of equine activities.

ROCK Notice of Privacy Practices Acknowledgement:
I have been given the opportunity to review the ROCK, Ride On Center for Kids "Notice of Privacy Practices". This document contains a description of the uses and disclosures of my healthcare and my rights regarding such information.  ROCK, Ride on Center for Kids displays the "Notice of Privacy Practices" Iin the Welcome Center.

I understand that ROCK, Ride on Center for Kids has the right to change its "Notice of Privacy Practices" and that if changes are made, a revised copy of the notice will be posted in the Welcome Center. I also understand that if I have any questions or wish to receive copies or a current copy of the "Notice of Privacy Practices"<I may contact:
Nancy Krenek and/or Shannon Middleton 
2050 Rockride Lane
Georgetown, TX 78626
Telephone(512) 930-7625 Fax:(512) 863-9231
By signing this form, I am acknowledging I have read the "Notice of Privacy Practices" and agree to the uses and disclosure information as described. I understand that refusing to sign this form does not stop disclosure of health information that has occurred prior to revocation of that is otherwise permitted by law without my specific authorization or permission. I understand that information disclosed pursuant to this authorization may be subject to re-disclosure by the recipient and may no longer be protected by federal or state privacy laws.

ROCK Photo Release

To the use and reproduction by ROCK of any and all photographs and any other audio/visual materials taken of me/my son/daughter/ward for promotional printed material, educational activities. Exhibitions or for any other use for the benefits of the program.
The above release applies to all family members and caregivers of this participant.  Contact your instructor if you have any questions about this policy.