Apple Tree Farm - 2023 Summer Program Application

Apple Tree Farm - 2024 Summer Program Application
Tiny Trotter
Young Rider Week
Advanced Program
Only for riders completing at 3-phase competitions.
Rider Name*

First NameLast Name
Rider Age*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*

Area CodePhone Number
Mother's Name

First NameLast Name
Mother's Cell Phone

Area CodePhone Number
E-mail
Mother's Work Phone

Area CodePhone Number
Father's Name

First NameLast Name
Father's Cell Phone

Area CodePhone Number
Father's Work Phone

Area CodePhone Number
Physician's Name

First NameLast Name
Physician's Phone

Area CodePhone Number
Insurance Company
Group#/Policy #
Emergency Contact

First NameLast Name
Emergency Phone #

Area CodePhone Number
Does the rider have any medical conditions or learning disabilities we should know about? Please explain
Please list any medications the rider is taking.
Briefly describe riding experience
Parent Signature*

Clear
Camp Week *
prevnext( X )
Young Rider Week$510.00
.

Young Rider Week -Early Drop Off$670.00
3% added to cover Paypal fees

Tiny Trotter Session$215.00
3% added to cover Paypal fees

Total $0.00
Should be Empty:

Apple Tree Farm - 2024 Summer Program Application