The Farm Experience

Summer Camp Registration

The Farm Experience
Applicant Information
Applicant's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
List all medical conditions
List all medications (prescribed and over the counter.) Notate if applicant is scheduled to take medication during camp time (provide medication name, instructions and time).
Does the athlete have any allergies and/or use an epi-pen?
Is the athlete prescribed an inhaler? If yes, please explain any instructions.
CLICK ON THE LINK BELOW TO COMPLETE THE MEDICAL WAIVER:

https://form.jotform.com/231165501593048

CLICK ON LINK BELOW TO COMPLETE LIABILITY WAIVER:

https://form.jotform.com/231165785116053
Please describe your motivations for wanting to learn about horsemanship, and what you hope to gain from the experience. Additionally, please explain any concerns you may have about interacting with horses, and how you plan to overcome them.
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.
Date

MonthDayYear
Date
Signature

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Summer Camp Registration

Applicant Information