Clone of Summer Camp Detailed Registration Form

Summer Camp Registration
Camp hours are Monday-Friday 9am-1pm

Total of $350 for 1 week of camp. $100 non-refundable deposit due at booking. Remaining balance due by the 1st day of your child's camp session. Payment will be processed via PayPal. If you need another form of payment please contact me.
Session 1 June 8-12Session 2 June 22-26Session 3 July 6-10Session 4 July 20-24
Camper Information

Please complete a separate form if you are signing up more than one child.
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade
MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
What is the camper's riding experience?*
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.*
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*

Powered by Jotform SignClear
Please check here to confirm that payment has been submitted
Should be Empty:

Summer Camp Registration