Make Deposit

Pay Full Amount

Camper’s Name: Parent’s Name: Address: City:                             State: Zip: Home Phone: Cell Phone: Email address: Age: Sex: Shirt Size: Emergency Contact during camp week: Medical Insurance Information: Policy: Group/Company: Carrier Address: Name of insured & relationship to participant: Social Security # of Policy holder: Social Security # of minor: Family Physician’s Name: Phone #: Address: Does your child have any medical condition, past or present that we should know of? If yes, please explain: Will you child need to take any medications during camp if so please list medication, dosage and specific time of day to be taken: Recommendations & Restrictions while at camp (ie: allergies, medication, swimming, etc.): Riding Experience: Special Requests for Cabin-mates & or Partners: How did you hear about us? Do you have any special questions? Desired Camp Dates: June 17-22 _____ June 24-29 _____ July 15-20 _____ July 29 - August 3 _____ August 12-17 _____ Regular Session ______ Advanced Session _______ Cost: $725.00 Nonrefundable deposit of $95.00 Balance due 2 weeks prior to camp date. Reserve your spot early to ensure reservation in camp.