Child's Name	First	Last
Start Date	1 2 3 4 5 6 7 8 9 10 11 12 / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	Weekley Monday Tuesday Wednesday Thursday Friday
End Date	1 2 3 4 5 6 7 8 9 10 11 12 / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Drop Off Time	:
Pick Up Time	:
Emergency Contact	First	Last
Telephone
Email
Age	Date of Birth 1 2 3 4 5 6 7 8 9 10 11 12 / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989
Allergies:
Medications:
Parent/Guardian Information
Name	First	Last
Address	Street
	City	State	Zip Code
Employer
Home Phone
Transportation	Name	Phone Number
Name of person(s) to pickup child		- -
Special Instructions:
Waiver   Through this document, I/we hereby waive and release, indemnify, hold harmless and forever discharge Big Boot Ranch, Inc. and Johnny L. Sturdivant and their agents, employees, officers, directors, affiliates, successors and assigns of any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities of every kind and nature arising from or in any way related to my/our child’s participation in any of the events or activities conducted by, on or around the premises of or for the benefit of Big Boot Ranch, Inc. and Johnny L. Sturdivant. By this waiver, I/we assume any and all risks and take full responsibility and, further, waive any claims of personal injury, death or damage to personal property associated with my child’s participation in any and all events at Big Boot Ranch, Inc., its facilities and/or against Johnny L. Sturdivant. This waiver and release includes the entire understanding between the parties and supersedes any prior oral or written agreement between them. By signature below, I/we assert that I/we understand and fully agree to these conditions as asserted herein.   Rates: Registration Fee:  $50 (non-refundable) Per Child Rates: (4-5 days):  $100/wk     Drop-In Rate (1-3 days): $25/day    Before/After Care: $5/day Group Rates:   2 Children: $175/wk    3 Children: $250/wk    4 Children: $325/wk Hours/Dates of Operations:   7a-6p Monday – Friday       Weekly fess are due Monday by 6pm for the current week.  Drop-In rates apply regardless of drop-off time.  Returned Check Fees: $30 each.
I accept By checking this box, you are accepting the terms of this Agreement. You are in agreement with and have read the preceding contract and waiver form and understand the information that has been presented.