Application for the Internship Program:

 Name __________________________

Parent’s Name (if under 18) ____________________________

Address________________________________

Phone Number ______________________

Work Number________________

E-mail ___________________________

Emergency Number _______________Relationship________

 Date of Birth _________________

Allergies (food and medical) ________________________________

Medications and dosage_____________________________

Time preferred (2 week min.)___________

Please include the following:

1. A complete resume.

2. List of goals, aspirations, and why you want to come.

3. 2 letters of recommendations from non-family.

4. Copy of your driver's license and insurance card.

5. A recent photo of yourself.

Forms may be mailed to WildeWood Farm, Inc. 4855 Heardsville Rd. Cumming, and GA 30040

 I, the parent or guardian of the minor listed above and of my own person, do hereby request WildeWood Farm, Inc. Cumming, GA, to accept my child, ward, or person as enrolled for activities in said WildeWood Farm, Inc. I, as an adult or 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 same, and related uses of the animals  - 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, ward, or person is injured during his/her/my stay at WildeWood Farm. I have read this, agree with it, and have advised my child or ward to obey rules of the intern program. I personally carry hospital insurance on my child, ward, and myself and accept this responsibility.

I, the undersigning, do hereby authorize, and give permission to WildeWood Farm, Inc. and its staff, individual or together, to act on the behalf of the undersigning I'm requesting and authorizing the provision of emergency medical services as deemed necessary in their discretion, to the child, ward, or myself. The undersigning 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, ward, or myself 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.

Signature: _________________________________________    Date: _________

            Parent or Guardian: __________________________________  Date:__________