Summer Horse Camp Registration Form

Camper Information

Name of Camper: *

Age: *

Date of Birth: *

Street Address: *

City: *

State: *

Zip Code: *

Phone Number: *

E-mail Address: *

Medical Conditions:

Please list any medical conditions.

Parent/Guardian information

Mother's Mobile #: *

Mother's Work #: *

Father's Work #:

Father's Mobile #:

Emergency Contact

In Case of Emergency, Notify: *

Phone Number: *

Relation: *

Supplies Checklist

Required Supplies: *

Shoes or Boots with a 1/2 heel for riding

Safety Helmet (If you do not have your own, we can provide one for you)

Long Pants for riding (either jeans or riding pants)

Campers are to bring lunch and a refillable water bottle daily (refrigerator available)

Clothes for non-riding activities (shorts, bathing suit, sneakers, hat, etc) ABSOLUTELY NO FLIP FLOPS!

By checking each box, you indicate that you meet these requirements.

Camp Sessions

Please select the camp session you wish to attend

Dates: *

Late Pickup Service (3 p.m. - 5 p.m.): *

Late Pickup Days:

Monday

Tuesday

Wednesday

Thursday

If you picked YES, please select what days service is needed.

Legal

Please select YES or NO giving Ban-Lynn Farm permission to use summer camp photos of your child in our brochures and web page.

Select permission: *

Pricing

Cost of Camp per Camper for the week - $250.00
Siblings – 10% discount ($25 off)
After Camp Care - $20 per day up to 2 hours
Method of Payment: Cash or Check

Checks payable to: Ban-Lynn Farm

Parent or Guardian Signature: ____________________________
Date: _________________
Print Name: ____________________________