Conditional Event Summer Camp App 2014 Camper's Name*Date of Birth*Height*Weight*Parent(s)/Guardian(s) Name*Home Phone*Work PhoneCell PhoneAddress*City*State*Zip*Parent/Guardian Email*T-Shirt Size*Youth Extra SmallYouth SmallYouth MediumYouth LargeYouth Extra LargeAdult SmallAdult MediumAdult LargeAdult Extra LargeAdult Extra Extra LargeMedical Insurance Carrier*Medical Insurance Policy #*AllergiesSpecial needs/conditions/disabilitiesDaily Medication (if applicable, please describe)Emergency Contact Name*Emergency Contact Phone*Riding Experience Please use the space above to tell us about your riding experiences and skills. All classes for students are divided according to ability level.Please tell us how you heard about usWebsiteFriend/ReferralSearch EngineOtherIf other, please explainFull Day Camp (ages 8-16) M-F 9:00 am-5:00 pm June 15-19 June 22-26 June 29-July 3 July 6-10 July 13-17 July 20-24 July 27-31 Aug. 3-7 Aug. 10-14 $395 per weekHalf Day Camp (ages 8-16) M-F 9:00 am-5:00 pm June 15-19 June 22-26 June 29-July 3 July 6-10 July 13-17 July 20-24 July 27-31 Aug 3-7 Aug 10-14 $325 per weekFour Day Camp M-F June 30-July 3 Full Day (9:00 am-5:00 pm) Half Day (9:00 am-1:00 pm) Full Day - $315.00 per week Half Day - $260.00 per weekTotal Price: $0.00 Deposit Price: $0.00 Weeks attending x $100Balance Due Price: $0.00 By June 1, 2015June 16 - 20 Price: $0.00 June 23 - 27 Price: $0.00 July 7 - 11 Price: $0.00 July 14 - 18 Price: $0.00 July 21 - 25 Price: $0.00 July 28 - Aug 1 Price: $0.00 Aug 4 - 8 Price: $0.00 Half June 16 - 20 Price: $0.00 Half June 23 - 27 Price: $0.00 Half July 7 - 11 Price: $0.00 Half July 21 - 25 Price: $0.00 Half July 28 - Aug 1 Price: $0.00 Half Aug 4 - 8 Price: $0.00 Four June 30 - July 3 Price: $0.00 FourHalf June 30 - July 3 Price: $0.00 Total Weeks Price: $0.00 *All applications require a $100.00 per week non-refundable deposit in order to be processed. You may use your credit card for the deposit by completing the information below. Please, also indicate how you would like to handle the balance due on June 1, 2015.Credit Card PaymentName on CardAddressCityStateZipType of Card Mastercard Visa Discover Credit Card NumberExpiration DateSecurity Code Δ
