Summer Camp Detailed Registration Form 2023

Summer Camp Registration 2023
Camper Information
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Weight*
Height*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Alternate Number

Area CodePhone Number
E-mail*
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Alt. Phone Number*

Area CodePhone Number
Other Person Authorized for Drop Off/Pick Up

First NameLast Name
Phone Number

Area CodePhone Number
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Does your child have any special needs? If yes, please describe.
Describe your child's experience and comfort level with horses and/or farm animals:
Optional: What is your child looking forward to doing at NSN camp? :)
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Never Say Never Stables during the selected camp. In exchange for the acceptance of said child’s candidacy by Never Say Never Stables, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Never Say Never Stables and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Never Say Never Stables including all instructors and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all equine and animal related activities, including riding. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Never Say Never Stables and its affiliates including Directors, Instructors, and Counselors to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Permission to use my child's photo for NSN's website, materials and/or social media purposes

Sure! I'll smile for the camera!No, thank you.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*

Clear
Select your camp week(s). There is a non-refundable $50 deposit required for each week selected:*

Jun 26 -Jun 30 Pre-K AMJun26-Jun 30 Teen Camp PMJuly 3-July 7 AM FULL DAYJuly 3-July 7 AM onlyJuly10-14 FULL DAYJuly 10-14 AM onlyJuly 17 -21 FULL DAYJuly 17-21 AM onlyJuly 24 -28 FULL DAYJuly 24-28 AM onlyJuly 31-Aug 4 FULL DAYJuly 31-Aug 4 AM onlyAugust 7-11 FULL DAYAugust 7-11 AM onlyAugust 14-18 FULL DAYAugust 14-18 AM onlyAugust 21-25 Pre-K, AMAugust 21-25 Teen Camp PMAug 28-Sep 1 FULL DAYAug 28-Sep1 AM only
Do you qualify for any of the following for this registration? (discounts cannot be combined)

Multi week discount, $25 off per weekSibling discount, $25 off per child
IMPORTANT! A non-refundable $50 deposit per camp week is required to reserve your child's choice of camp week(s). Click the blue "Shop" button on the camp web page, or Venmo @neversayneverstables or submit checks or money orders within 3-5 business days of completion of this online registration to:

Never Say Never Stables

906 Maple Drive

Webster, NY 14580

*Please put child's name and camp week(s) in memo line.
I understand a non-refundable $50 deposit per week is required to reserve my child's camp week(s). I agree to mail deposit payment within 3-5 business days of this application submission.*

Clear
Thank you! A confirmation email will be sent to you upon receipt of your deposit(s).
For Office Use Only: Deposit paid $________ Balance $___________due upon first day camp.
Should be Empty:

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Summer Camp Registration 2023

Thank you! A confirmation email will be sent to you upon receipt of your deposit(s).