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: *

Relationship: *

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 : *

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

Pee Wee Camp Cost per camper for the week - $175.00
Junior Camp Cost per Camper for the week - $250.00
Advanced Camp Cost per Camper for the week -$300.00
Overnight Camp Cost per Camper for weekend -$150.00
Siblings – 10% discount ($25 off on junior camp and 17.50 off on Pee Wee Camp)
After Camp Care - $5.00 per child, per hour, per day
Method of Payment: Cash or Check

Checks payable to: Ban-Lynn Farm

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

You Can Help Every Child Go To Horse Summer Camp In 2011

Ban-Lynn hopes to give every child a chance to enjoy Horse Summer Camp and the experience of being close to horses. With the help of the community we have given part and whole scholarships to less fortunate children in our last 6 summer camps. A full scholarship is $250.00 for one child for one week of horse camp.

If you would like to help a child have a wonderful experience with horses, please contact Ban-Lynn Farm at 910-564-5608. Any amount you can donate can build a scholarship for a child in our community. You will receive a special set of camp photos taken during the week of camp of the child you help sponsor.

On behalf of all the children in our community we want to thank you for any donation you can give.

Banks and Linda Hasque

2432 Hobbs Road | Roseboro, NC 28382 | Phone: (910) 564-5608 | Fax: (910) 564-3327 | Login
Copyright 2010-2011 Ban-Lynn Farm, LLC

Summer Horse Camp Registration Form

Donation