Camp Enrollment Form

Bryant Manor Equestrian Center Kids Camp Registration
CHILD INFORMATION:
Child Name*

First NameLast Name
Age*
Birth Date*

MonthDayYear
Camp date(s) attending*
Date(s) attending
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Emergency contact

First NameLast Name
Emergency Phone Number

Area CodePhone Number
MEDICAL INFORMATION
Physician Name

First NameLast Name
Physician Phone Number

Area CodePhone Number
Medical Concerns (Allergies, Medications, etc)
Horse experience

BeginnerIntermediateExperienced
Signature

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