Horse Camp Registration Form

Name

First NameLast Name

Age

Birth Date

Date

Entering Grade (Fall 2018):

Gender

Child's Horse Experience

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?

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

If yes, please give us details

Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Does the child have any allergies?

If yes, please give us details

Is your child currently taking medication?

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

Please select the camp session you wish to attend:

Emergency Contact

Child’s Health Information

Parent Permission