WildeWood Farm Summer Camp Registration 2023
Please complete the form below to register your child for camp.  Submit ONE FORM PER CHILD.
Contact Hannah Zapletal at 770-843-2478 or hannah@wildewoodfarm.com with any questions.
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Email *
Welcome to Camp!!
Summer Camp Session(s) 2023 - Check all that apply *
Participant's Last Name *
Participant's First Name *
Participant's Age *
Participant's Grade (Fall 2023) *
Parent/Guardian Name(s) *
Address *
Phone Number *
Primary E-mail Address *
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Relationship *
I, the parent or guardian of the minor listed above, do hereby request WildeWood Farm, Inc. Cumming, GA, to accept my child or ward as enrolled for activities in said WildeWood Farm, Inc. I, as an adult and as the parent or guardian of said minor, know that by the very nature of the activities at WildeWood Farm, Inc. – riding horses, care of and interaction with farm animals, and related uses of the animals, in addition to running and playing - there exits some element of risk or injury.  I accept the said risks and agree to hold harmless the Owners or Employees of WildeWood Farm, Inc. in the event my child or ward is injured during his or her stay at WildeWood Farm. I have read this, agree with it, and have advised my child or ward to obey rules of the camp. I personally carry hospital insurance on my child or ward and accept this responsibility *
I, the the parent/guardian do hereby authorize, and give permission to WildeWood Farm, Inc. and its staff, individual or together, to act on the behalf of the parent/guardian in requesting and authorizing the provision of emergency medical services as deemed necessary in their discretion, to the child or ward. The parent/guardian guarantees payment of all customary fees and charges in connection with the rendering of such medical services. This release/authorization shall be effective during the period that the child or ward is involved with WildeWood Farm, Inc. and is not revocable during such period. *
Warning: Under Georgia law, an equine activity sponsor or professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities pursuant to Chapter 12 of Title 4 of the official code of Georgia Annotated. *
Under Georgia law, there is no liability for an injury or death of an individual entering these premises if such injury or death results from the inherent risks of contracting COVID-19.  You are assuming this risk by entering these premises.O.C.G.A 51-16-3
Please indicate below whether or not you, the parent/guardian of the participant, allow for the use of the participant's photo/likeness in promotional media produced by WildeWood Farm or its employed media personnel. *
Please select your method of payment for the $100 deposit.  Balance for camp is due the first day of the camp session. NOTE: If using PayPal, select "Send To Someone You Trust" to avoid fees. *
Would you like to pre-order a Camp Shirt ($15)?  Please give us your size and we'll have one ready for you! *
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Amount Paid (Check all that apply) *
Electronic Signature of Parent/Guardian (FULL NAME) *
Date of Electronic Signature of Parent/Guardian *
A copy of your responses will be emailed to the address you provided.
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