Horse Camp Registration Form

Name

First NameLast Name

Age

Birth Date

Date

Entering Grade (Fall 2018):

Gender

Child's Horse Experience

N/APony RideTrail RideLesson

Child's T-shirt Size

Name

First NameLast Name

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Please select the camp session you wish to attend:

Session #1$500.00

Session #2$600.00

Session #3$675.00

Session #4$750.00

Total $0.00

Will you be using after child care?

NeverSome DaysAll Session

Do you give permission for anyone else to pick-up your child?

YesNo

If yes, please give us details

Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Does the child have any allergies?

N/AYes

If yes, please give us details

Is your child currently taking medication?

N/AYes

If yes, please give us details

I certify that my child is healthy and free of problem that
could be deleterious to his / her participation in the Horse Summer
Camp. In case of injury, I wish to be contacted as soon as possible at the telephone number listed previous.

I also give permission to treat my child in the event of an emergency if I or the
emergency contact cannot be contacted. In the event of serious illness or injury, and so that my child may be sent to local hospital via ambulance, I understand that I am responsible for all charges either through health insurance or otherwise.

Signature

Horse Camp Registration Form

Camper Information

Parent Information

Camp Session

Emergency Contact

Child’s Health Information

Parent Permission