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Hobby Horse Hill Equestrian Center Summer Day Camp

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					Hobby Horse Hill Equestrian Center
Summer Day Camp Registration Form

Contact Information

Name
Street Address
City ST ZIP Code
Home Phone
Alternate Phone
E-Mail Address


Day Camp Sessions
During which week would you like your child to participate?

Week 1 - 6/13/11 – 6/17/11
___ AM (ages 5-8)                   ___ PM (ages 9-12)


Week 2 – 6/20/11 – 6/24/11
___ PM (ages 13-18)


Week 3 – 7/11/11 – 7/15/11
___ AM (ages 5-8)                   ___ PM (ages 9-12)


Week 4 – 8/8/11 – 8/12/11
___ AM (ages 5-8)                   ___ PM (ages 9-12)


Emergency Contact Information
Who should we contact in case of an emergency?
Name
Street Address
City ST ZIP Code
Home Phone
Alternate Phone
Relationship to camper
Name
Street Address
City ST ZIP Code
Home Phone
Alternate Phone
Relationship to camper
   Contact #2:

Special Needs

Does the camper have any special needs or medical conditions that we should be aware of? Please include any
activities that you do not wish your child to participate in.




   Agreement and Signature
   By submitting this application, I understand that I am enrolling my child in the Hobby Horse Hill
   Equestrian Center, LLC Ponypalooza Day Camp.

   Name (printed)
   Signature
   Date


   Photo Release
   I [ ] DO [ ] DO NOT consent to and authorize the use and reproduction by HOBBY HORSE HILL
   EQUESTRIAN CENTER LLC of any and all photographs and any other audio/visual materials taken for
   promotional material, educational activities, exhibitions or for any other use for the benefit of the
   program.

   Name (printed)
   Signature
   Date


  Please remit form and payment to:

  Hobby Horse Hill Equestrian Center, LLC.
  7559 Yankee Street
  Fredericktown, OH 43019

				
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posted:10/9/2011
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