Summer Camp Registration Form

Is your child crazy about horses? Are you looking for a unique summer activity filled with horses? Then our Summer Camps are for you!

What will I learn when riding?
Our Camps are designed to create bonds, and promote safety all while having fun. Camp riding activities are designed to teach the basics, and improve on already learned skills.

What do I need to bring?
• Boots with a heel
• Sunblock and bugspray
• Long pants for riding
• Lunch and snacks and lots of water
• Helmet or Bike Helmet
• Change of clothes (Shorts, running shoes, hat)

When do I come to camp?
• Camp runs from 9:00am to 3:00pm Tuesday through Friday

What is the cost?
• Single day camps are $110 for the day
• 4 day camp is $360 for the week

Registration and Payment options
• Registration forms must be submitted through this form.
• Payment can be submitted via etransfer to charlotte@paintedhilltop.com with the password camp
• A non-refundable deposit of $160 is due with registration form.

Camper Name*

First NameLast Name

Camper Age*

Name(s) of Parent(s)/Guardian(s)*

Cell Phone Number - Can we text you? Yes or No*

Email*

example@example.com

Address*

Incase of emergency contact?*

Family Doctor*

Health Card Number*

Any allergies or medical conditions we should be aware of?*

What best describes the Campers riding experience *

T Shirt Size*

Which camp(s) are you registering for?*

Session 3 - August 1 - August 4 - 3 SPOTS REMAININGSession 4 - August 15 - August 18 - 3 SPOTS REMAINING

Are you registering for a Single Day, 2 Day or Full Camp Option?

Single DayTwo DayFull Camp

If Single, Two day camps are chosen - Please let us which day(s) you are interested in

Media Release

I authorize Painted Hilltop Farm Summer Camp to record my child’s image and voice while participating in programs.

I understand and agree that these audio, video, film and print images may be edited, duplicated, distributed, reproduced, broadcasted, and reformatted in any form and manner without payment of fee in perpetuity.

I also give permission to Painted Hilltop Farm to use photographs, audio and video of my child for promotional purposes, including but not limited to the web site, Annual Report, Newsletter, Summer Camp Guide, and other marketing and communication materials.

Do you Authorize Permission?*

I do authorize permissionI do not authorize permission

THIS SECTION MUST BE SIGNED BY PARENT AND/OR GUARDIAN BEFORE REGISTRATION IS ACCEPTED.

In consideration of being allowed to participate in any way in Painted Hilltop Farms equestrian program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
I KONWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary term and conditions for participation. If, however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Painted Hilltop Farm, their officers, officials, and/or employees, other participants, and , if applicable, owners and lessors of premises used to conduct the event(“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

I, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Signature*

Clear