SADDLE RIDGE SUMMER CAMP ENROLLMENT APPLICATION
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Child's NAME_____________________________________________AGE:________HT:______WT_____
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ADDRESS________________________________________________MOTHER______________________
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TOWN_____________________________________ZIP______________DAD______________________
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PHONE____________(h)_________________(CELL)______________GUARDIAN____________________
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WORK#____________________(ILLNESS/EMERGENCY)_________________________________________________________
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EMERGENCY CONTACT______________________________________(RELATIONSHIP)_______________________
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MEDICAL HISTORY_________________________________MEDICATIONS_________________________
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DESCRIBE:___________________________________________________________________________
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ALLERGIES-FOOD OR OTHER:_____________________________________________________________
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ALL IMMUNIZATIONS MUST BE UP TO DATE (PLEASE SEND COPY )
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ATTENDED CAMP BEFORE:_________________
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RIDING Discipline: ENGLISH _____WESTERN_______
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WALK______WALK/TROT________WALK/TROT/CANTER______
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CROSSRAILS__________________
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REQUESTED WEEK(S)_________________________ _______________
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COMMENTS:
A deposit of $225.00 is required, balance due 2 weeks prior to start of camp. TOTAL:$450.00
Checks payable to Saddle Ridge Riding Center, Inc.
Cancellation Policy: must be notify 1 week prior to sign up week.
$30.00 Bank Fee for returned checks
PAYMENT ENCLOSED______________CHECK#___________
CREDIT CARD: VISA MC DISCOVER
CARD#_________________________
EXP DATE:(MM/YR)_______________
SIGNATURE:_____________________
NO CHILD WILL BE RELEASED TO A NON-FAMILY MEMBER WITHOUT WRITTEN PERMISSION FROM PARENT/GUARDIAN
DISCLOSURE: PLEASE INFORM ALL STAFF OF ANY HEALTH ISSUES. MEDICATIONS, SPECIAL NEEDS. OUR AGENTS,Affiliates,AND
ASSOCIATES FOR HIRE ASSUME NO Responsibility FOR DAMAGES OR HARM THAT MAY RESULT DIRECTLY OR INDIRECTLY AS OF A
RESULT OF NON-Disclosure.
SIGNATURE: PARENT/GUARDIAN___________________________________________________
