Winter Day Camp Enrollment Form

Winter Day Camp Enrollment Form

Innovation Arabians, LLC
Camper's Information
Camper's Name

First NameLast Name
Age
Gender
T-Shirt Size
Date of Birth

MonthDayYear
Date
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
- The parents/guardian listed below will be the authorized person to pick-up the child after the camp.
- The parents/guardian listed below will also be the primary emergency contact person.
Name

First NameLast Name
Relation
Phone Number

Area CodePhone Number
Name

First NameLast Name
Relation
Phone Number

Area CodePhone Number
Medical Information
Does the child have any allergies? If yes, please list them below:
Does the child have any current medical conditions? If yes, please list them below:
Payment Details
Registration Fee
prevnext( X )
One day$125.00
Register for one day only

Two days$225.00
Register for two days only

Three days$325.00
Register for three days

Total $0.00
Dates Chosen:
Options are December 29th, December 30th, and January 5th
A non-refundable deposit of $50 is due at sign-up. The remainder of the funds will be collected on the first day of camp. Deposits can be made by check made out to Innovation Arabians, or by Zelle to Diane Lapham (email is dianefl1013@yahoo.com). If using Zelle, please include a $.50 processing fee.
Authorization
Parent/Guardian Signature

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- I, the parent/guardian of this camper gives authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
- I released the organizers, coaches, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment.
- I consent to photos and/of videos of my child to be used for business promotion.
- I confirm that all information given in this form is true, complete, and accurate.
Should be Empty:

Winter Day Camp Enrollment Form

Camper's Information

Parent/Guardian Information

Medical Information

Payment Details

Authorization