July 21st-24th Specialty

Summer Camp Registration

July 21st-24th noon-3:30pm $325 + $25 deposit
Camper Information
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name*

First NameLast Name
Cell 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
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.*
I am attending an afternoon specialty camp:*

yesno
Same group friend request
A $25.00 non-refundable registration fee per child is required with the application to reserve your spot. You may write a check or use paypal for the depoit. Balance due of $325 must be paid the first day of your desired session. You can write a check or pay cash. Make checks payable to: Ride With Pride, Inc. 480 West Highland Southlake, Tx 76092. Ride with Pride reserves the right to cancel a camp that does not meet the minimum number of students.
Pay deposit through PayPal
prevnext( X )
Camp Deposit
$25.00

Pay by check$25 mail in or bring the first day of camp
$ Free

Total

$0.00
Should be Empty:

Summer Camp Registration