Please complete all fields. Use a separate form for each child.

   Child's name:     Age: Yrs.

      Birth Date:(mm/dd/yy)    Sex: Male Female  

Parents or legal guardian's full names: 

             Mr. Mrs. Ms.

Street Address:  

               City:     State:    Zip:

   Home Phone:        Work Phone:

      Cell Phone:     E-mail address:

             Mr. Mrs. Ms.

Street Address:  

               City:     State:    Zip:

   Home Phone:        Work Phone:

      Cell Phone:     E-mail address:

Emergency contacts other than parent or guardian: 

Name: Relationship:

    1st Phone:     2nd Phone:

Name: Relationship:

    1st Phone:     2nd Phone:

Authorized pickup person in addition to parents or guardians: (I.D. must be presented at time of pickup).

            Name:

Street Address:

               City:     State:     Zip:

            Phone:

Please list in full any allergies, or medications that require attention:

Date of last tetanus shot: (mm/dd/yy) 

Are all of your child's vaccinations up to date? Yes No

Do we have permission to administer Benadryl,Tylenol if needed?   Yes No

Do we have permission to administer minor first aid if needed?      Yes No

Do we have permission to seek medical attention in an emergency? Yes No

Child's doctor's name:     Phone:

 Child's dentist name:     Phone:

Health card or Blue Cross number: *(Required)

Equestrian Program Only.  Which 1 week session(s) do you wish to enroll your child in?

Week 1 (June 23-June27 )   Week 2 (July 7-July 11)    *Closed week of 4th. of July

Week 3 (July 14 to July 18)  Week 4 (July 21 to July 25)

Week 5 ( July 28 to Aug. 1   Week 6 (Aug. 4 to Aug. 8)

Week 7 (Aug. 11 to Aug. 15) Week 8 (Aug 18 to Aug.22)

 Riding skill level: Beginner Intermediate Advanced

Comments:

Our Photo Policy... Smile!

We may take you and/or your picture at Recreation programs & events. Please be aware that these photos are for our use and may be used in future brochures, flyers and publicity. Please let us know if this presents a problem. Note: We will not use you or your child's name in any photos or ads. Thank You...

Upon Receipt of your Application and Deposit you will receive additional forms that must be signed and returned prior to your child starting .

Payment must be Received in Full by May 1st.for all Summer Program Sessions. If payment is not received we cannot hold your spot.

 Remember to include your $100.00 non-refundable deposit per child, per 1session.  No Registration forms will be accepted or processed  without the $100.00 non-refundable deposit.  

We accept all major Credit Cards On-Site or by Phone for your convenience...

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