STOP!! This is an old registration and will NOT work for 2023 Camps. Please CLICK HERE to register for 2023.

Welcome to the High Hopes Summer Camp Registration Form!


summer camp image
Please click Next Page to start your form.

Welcome!

We will pre-fill the registration form for:



Not you? or Form Blank?

Click here to provide your name and Date of Birth again (try a different spelling or a full name vs. nickname and use the date format MM/DD/YYYY, i.e. 01/05/2010), or click here to begin a blank Summer Camp Registration.


Please confirm the Date of Birth to continue.





Ok - please enter your name and email address below. We will reach out to you to correct this issue.

Welcome!

We will pre-fill the registration form for:



Not you? or Form Blank?

Click here to provide your name again (try a different spelling or a full name vs. nickname, or click here to begin a blank Summer Camp Registration.


Please confirm the email you used when you contacted us.





Ok - please enter your name and email address below. We will reach out to you to correct this issue.



Summer Camp registration and financial aid closes May 10th. Horse Sense, VetKids registration and financial aid closes July 8th.
Camp Info
Camp runs Monday-Thursday 9:00 AM to 12:30 PM each day.

Week 1: 6/27 to 6/30 Ages 8 to 13
Week 2: 7/11 to 7/14 Ages 4 to 7
Week 3: 7/18 to 7/21 Ages 5 to 13
Week 4: 7/25 to 7/28 Ages 4 to 7
Week 5: 8/1 to 8/4      Ages 8 to 13

May 10th: Summer Camp registration & financial aid closes
May 17th: Final Camp paperwork deadline (physician's statements, etc.)

Camp runs Monday through Thursday from 9:00 AM to 1:00 PM each day.
Campers may be offered additional weeks if space is available.
VetKids Info


Participant Intro
Thank you for your interest in High Hopes Camps! All participants MUST complete:

1. This registration
2. Physician's Statement (download here)*

*The Physician's Statement is only required every three years, unless otherwise requested by High Hopes staff. If you have a current one on file it will be indicated in the form below.

If the participant receives OT/PT and/or mental health services, you may also provide:
Primary Contact Info
Please enter information for the parent, guardian, staff or representative who is completing this form.



























Please complete the remainder of the form with the prospective participant's information. Thank you!

Participant Information

Enter the Contact information for the CAMPER.








Accurate participant weight reporting is essential for appropriate horse matches. Our maximum riding weight limit is 180lbs. Please round to the nearest whole number, in pounds, i.e. "145".



Participant Contact Information











Don't have an email? This field is required, so type none@none.com.










Many grants that help offset participant fees are based on the participant's residence location. Even if they will not receive mailing there, please let us know the town and county of their residence.


Billing & Transportation Contact Info

Billing Contact Information



























Transportation Info
You can leave this blank if the participant will transport themselves, be transported by the Primary Contact listed above, or you're not sure of this info yet.


Legal Guardian Info
Please indicate who the participant's Legal Guardian is.


Provide the Legal Guardian's full name and best contact info (e.g. phone or email). Limit 255 characters.
In case of emergency, contact (parent if minor):





If you have no allergies, please enter "none" or "nka".

Participant Registration


Check Yes if there are medications to be administered during camp hours, including as-needed meds like epi-pen, inhaler, etc.
Disability Info




Seizure Info





Pertinent information may include things like: temperature or light sensitivity, g-tubes, tactile defensiveness, sensory aversions, fatigue, high or low pain tolerance, self-stimulatory behaviors, etc

For medications to be adminstered during camp hours, please include NAME, DOSE, and TIME. **Include inhalers, epi-pen, etc.**

Tell us about you!

Tell us more about your characteristics and abilities. This will help us match you with the right program and team for your goals. 









Please read and sign the following statements.

Consent to Camp Polices
Click here to review the Camp Policies.

If applicant is under 18 years of age, parent/guardian signature is required.

Authorization for Emergency Medical Treatment
In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to secure and retain medical treatment and transportation, if needed, and release records upon request to the authorized individual or agency involved in emergency medical treatment.  

If applicant is under 18 years of age, parent/guardian signature is required.

Photo, Video, and Publicity Release

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 such image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.   



If applicant is under 18 years of age, parent/guardian signature is required.

Confidentiality Policy

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as confidential information.  I shall never disclose confidential information to anyone other than High Hopes staff.  I must seek staff permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.


If applicant is under 18 years of age, parent/guardian signature is required.

Liability Release

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 are greater than the risks 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 High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating in activities at High Hopes from whatever cause, including but not limited to the negligence of these related parties.

 

The undersigned acknowledges that he/she has read this registration 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. 


If applicant is under 18 years of age, parent/guardian signature is required.

Participant Forms Acknowledgement

Contact Information