Horse Day Camp 2024

Send non-refundable $25 deposit for each camp attending to: The Promised Land Camp 220 Boy Scout Rd Conestoga Pa 17516

Please include name of camper and name of camp attending.

Zelle available upon request

Select each camp attending*

Horse Day Camp - June 24-26

Camper First and Last Name*

Gender*

MaleFemale

Birthdate*

MonthDayYear

Age at Camp*

Mother Name*

Cell Phone*

Father Name*

Cell Phone*

Email to use for confirmation and communication*

example@example.com

Address*

Address

Street Address Line 2

State

Zip

Insurance Provider*

Other Phone#

Policy #

Date of Tetanus*

Are your Child's shots up to date?

Does the camper have any allergies or is the camper allergic to any medication? Is there any additional pertinent medical information or special needs the Promised Land Camp staff should know?

If, in the event of an emergency, the parent/guardian cannot be contacted, please contact:

Emergency Contact Name*

Relationship to Camper*

Address*

Address

Street Address Line 2

State

Phone*

Other Phone

Area CodePhone Number

Can your Child have Acetaminophen?*

YesNo

Can your Child have Ibuprophen?*

YesNo

Read and Sign: I give permission to the Promised Land Camp staff to seek medical emergency treatment for my child. By signing this form, I understand that I am giving permission for my child to participate in the Promised Land Camp programs. I understand that certain risks may be involved with participation in Promised Land Camp activities and that certain activities may be physically demanding and potentially dangerous. I understand that the camp offers equine activities and that horses are inherently dangerous animals. I agree and hereby state that participation in Promised Land summer camp activities is strictly voluntary and is the choice of my child and myself. I further state that by signing this form, I agree to assume for my child, myself, my heirs, and executors all risks of physical injury or emotional upset which may be a result of my child's participation in a Promised Land Camp program. In addition, I agree to release from liability the Promised Land Camp, its employees, volunteers, agents and affiliates in the event of such result. I agree to this form and its contents, and to be bound by its terms. I agree that all information stated is correct and complete, and to the best of my knowledge. I give permission for the Promised Land Camp staff to take photos of my child during camp and give permission for these photos to be used for marketing purpose (i.e. website, brochures, etc) by the Promised Land Camp.

Date

Parent Signature