Horseback Adventure Camps Registration Form
Camp: Spring Summer 1 Summer 2 Fall

Name of Participant:

Address: Apartment/Suite:

City: Province: Postal Code:

Telephone: Date of Birth: Age:

Medical Information

Allergies:

Emergency Contact Name and Telephone Number during camp hours

Name: Telephone Number:

Parent or Guardian Information

Parent or Guardian Name(s):

If your address and phone number are different then the Participant address please enter it below, otherwise check the same as button.
Same as Participant

Address: Apartment/Suite:

City: Province: Postal Code:

Telephone Number: (Home) (Work)

Email:

Photo Release

I herby consent to and authorize the use and reproduction of any and all photographs and/or any audio-visual materials taken of me/my son/my daughter/my ward, for promotional printed material, educational activities or for any other use for the benefit of the program.

Yes, I give authorization. No, I do not give aurthorization.

Release and Acknowledgement Form

Please read and complete the horseback riding participation and return with completed Registration form. If you have already completed a form, please check form on file.

Form Attached Form on file

Transportation Permission

I give permission for my son/daughter to participate in vehicle transportation during Horseback Adventure Camps.
__________________________________________
Parent/Guardian Signature		__________________________________________
Print Name

Date: _______________________________