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2012 Camp Registration FormEagles Rest 2012 Summer Horse Camp Registration Form Camper Information: Name:________________________________Age:______Sex:_____ Address__________________________________________________ City:_________________________________State_____Zip________ How did you hear about our camp?____________________________
Camper Riding Ability: _____Beginner: Little or no riding experience or lacks confidence _____Novice: Can ride a gentle horse at a walk, perhaps trot a little _____Intermediate: Can walk, trot, canter but needs to improve skills _____Advanced: Several years experience and/or instruction, good form and control Comments about riding experiences: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ We are offering 5 weeks of camp this year. Overnight camp for girls ages 8 thru 15 and day camp for boys and girls ages 8 thru 15. Overnight camp is $400 per camper per week and is limited to 12 girls only. Day camp is unlimited and is open to both girls and boys at the cost of $100 per camper per week. _____Week 1, June 18-June 22 Day camp only Arrive at 9:00 am, Bring Lunch, Pick up is at 5:30 pm. Drinks provided. _____Week 2, June 24-June 29 Overnight camp only. Arrive Sunday between 5:00-6:00 pm. Pick up is Friday by 7:00 pm _____Week 3, July 9-July 13 Day camp only. Arrive at 9:00 am. Bring Lunch. Pick up is at 5:30 pm. Drinks provided. _____Week 4, July 16-July 20 Day Camp only. Arrive at 9:00 am. Bring Lunch. Pick up is at 5:30 pm. Drinks provided. _____Week 5, July 22-July 27 Overnight Camp only. Arrive Sunday between 5:00-6:00 pm. Pick up is Friday by 7:00 pm. If you are bringing a friend and wish to be in the same group, please give us your friend's name:__________________________________________ Earlybird discount of $25 off overnight camp, one week, If you register before June 1, 2011. Full payment must accompany this registration form and the Eagles Rest Liability Release form. Registration forms need to arrive at camp no later than 5 days before the start of camp. You can call (386) 659-1650 and let us know if your registration is in the mail so we can verify openings. Each camper needs riding boots to ride horses (tennis shoes are not acceptable for riding), Jeans or stretch type pants for riding. An approved riding helmet (or one will be provided) and LOTS of sun screen and bug repellant. A more complete packing list is available on our website at www.eaglesrest.org CONTACT INFORMATION: Parent/Guardian Name: ________________________________________________________ Phone: Cell ( )__________________ Home ( )__________________ Address:_______________________________________________________ City:___________________________State:_________Zip:______________ Parent/Guardian Name:_________________________________________________________ Phone: Cell ( )__________________Home ( )____________________ Address:________________________________________________________ City:___________________________State:_________Zip:_______________ Alternate Contact Name:__________________________________________________________ Phone: Cell ( )__________________Home ( )_____________________ Address:_________________________________________________________ City:__________________________State:__________Zip:________________ Professional Contact Doctor's/Clinic's Name______________________________________________ Address:_________________________________________________________ City:__________________________State:_____________Zip:_____________ Phone: ( )_______________________________ Medical Insurance Carrier ___________________________________________ Allergies (foods such as peanut butter and plants such as alfalfa hay) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Date of last Tetanus Vaccination __________________________ Other things you think we should know about your child? (Physical limitations, mental, social, or psychological) ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Please attach a copy of the Eagles Rest Liability Release form to this registration form and mail with your check to: Eagles Rest Camp Attention: Cindy Hicks 1221 N. CR 315 Melrose, FL 32666 |
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