2025 Horse Camps Registration Form

Name

Address

Phone

Email

example@example.com

Age

Riding Experience

Any known medical conditions

Any known allergies

Emergency Contact

Select Camp(s)

April 14 – Buckaroo Spring Break Camp - 9amto 12pm - Ages 4-7 - $55for day - Registration & $55 fee due by April 1stApril 15-17 – Spring Break Camp - 9am to 2pm - Ages 8-16 - $150 for all three days or $75 per day - Registration & $75 fee due by April 1stJune 16-20 – Summer Horse Camp - 9am to 2pm - Ages 8-16 - $250 for the week or $75 per day - Registration & $75 deposit due by June 1stJune 23-25 – Buckaroo Horse Camp - 9amto 12pm - Ages4-7 - $150 for all three days or $55 per day - Registration & $75 deposit due by June 1st

Multiday camps have a per day if you cannot attend the full week Please let us know which days your child is attending any given camp

Days attending camp

We are offering camp tee shirts for $15 which would be due at the timeof registration. If you would like toorder a camp tee please give us the shirt size needed

Shirt Size

Registration form and NONREFUNDABLE deposit due by first of the month of camp to hold spot. Balance due the week before camp. $25 late fee for late entries (if there is room)

Toms Performance Horses, LLC 2965 Hat Creek Rd Brookneal, VA 24528

Electronic Payments Venmo: Danielle-Kernen (0377) PayPal friends and family: Danielletoms80@gmail.com

I, the camper or guardian of the minor (under 18), enter the above horse at my own risk subject to all rules and regulations of the show and Hat Creek Equestrian. I agree if any injury or death occurs to the animal exhibited, myself or minor exhibitor, spectators, or damage to any personal property on the grounds, that I hereby waive and release any claim to liability whatsoever from Hat Creek Equestrian, all committees, property owners, employees, members, and volunteers whether the injury, death, or damage be causedby gross negligence or simple negligence of Hat Creek Equestrian.

Exhibitor Signature or guardian if under 18

Date