SADDLE RIDGE SUMMER CAMP ENROLLMENT APPLICATION 2012
- CHILD’S NAME_________________________________________AGE:________HT:______WT_____
- STREET ADDRESS____________________________________________________________________
- TOWN_____________________________________ZIP______________
- PHONE____________(Home)_________________(Cell)______________ (Work)
- EMERGENCY CONTACT_________________________________(RELATIONSHIP)_________________
- ALLERGIES/MEDICATIONS/SPECIAL NEEDS_______________________________________________
- DESCRIBE:__________________________________________________________________________
- ALL IMMUNIZATIONS MUST BE UP TO DATE (PLEASE SEND COPY )
- DISCIPLINE: ENGLISH_____WESTERN_____WALK_____ TROT______ CANTER____ CROSSRAILS____
- Permission for my camper (ages 8 and up) to participate in trail rides: YES______ NO_______
- Please include a grooming kit for an additional $15.00: YES________NO________
- Please select the week(s) you would like your camper to attend:
___Week 1- June 25-June 29 ___Week 6- July 30-August 3
___Week 2- July 2-July 6 ___Week 7-August 6-August 10
___Week 3- July 9-July 13 ___Week 8- August 13-August 17
___Week 4- July 16- 20 ___Week 9- August 20-August 24
___Week 5-July 23-July 27 ___Week 10-August 27-August 31
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. $30.00 Bank Fee for returned checks
Cancellation Policy: No Refunds
PAYMENT ENCLOSED: $225.00
CHECK#___________
CREDIT CARD: VISA MC DISCOVER
CARD#___________________________________ EXP DATE:(MM/YR)_____________________
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,OR SPECIAL NEEDS. OUR AGENTS, AFFILIATES, AND ASSOCIATES FOR HIRE ASSUME NO RESPONSIBILITY FOR DAMAGES OR HARM THAT MAY RESULT DIRECTLY OR INDIRECTLY AS A RESULT OF NON-DISCLOSURE.
SIGNATURE: PARENT/GUARDIAN___________________________________________________
