Registration Form




2011 Horseback Riding Camp Registration Please complete and return to: Michelle Hargreaves, 4725 Montford Rd., Pfafftown, NC 27040 email: michelle@hiddenkstables.com Print or Type: Camper’s Full Name_______________________________ Sex: Male _______Female ______ Prefer to be called_______________________ Birthdate ______________ Age at Camp _____ Home Phone_____________________ Mobile __________________ email________________ Person responsible for payment____________________ Relationship ____________________ Mother’s name ____________________________ Work Number ________________________ Father’s name______________________________Work Number________________________ Emergency Contact (other than parents): Name ____________________ Number___________ Camper’s School__________________________________ Present Grade _________________ Is your child emotionally, behaviourally, or physically challenged? _____No _____ Yes (Explain) Intermediate Session Attending: Riders need to be able to walk, trot, and canter your horse __Full___ June 27-July 1 Beginner & Intermediate Session Attending: __Full___ July 18-22 __Full___ August 1-5 _____ August 8-12 Advanced Session: _____ July 6-8 Please note for the Advanced week of Juy 6-8, you must be able to walk, trot, and canter your horse, or have Michelle’s approval to attend. Weekly Session Fees: $295/child $100 deposit, remainder of money is due at the beginning of camp week Guidelines: In the event of an emergency in which the parent/guardian cannot be contacted, the parents/guardian agrees to allow the staff members of Hidden “K” Stables (HKS) to take appropriate action in the best interest of the child. I permit HKS to use picture of my child as a camp participate in promotional literature, promotional videos, and the HKS website, which are published and used by HKS. I understand that there are inherent risks associated with horseback riding, and I agree to assume them on behalf of my child. All children must wear a helmet when riding. Helmets will be provided by HKS, but children may bring their own provided that they are SEI certified ASTM helmets. I understand that HKS assumes no responsibility for injuries or illnesses which my child may sustain as a result of his/her physical condition or resulting from his/her participation in camp activities. In consideration of participating at camp, I hereby voluntarily release and discharge HKS, its agents, contract services and employees from any and all claims for injury, illness, death, loss or damage which my child may suffer as a result of his/her participation in camp activities. Participants are responsible for their own accident insurance when participating in activities offered at HKS I understand that while HKS will make every attempt to provide reasonable accommodations for every applicant, the HKS staff reserves the right to decline the application of, or send home, any child who according to the Director’s discretion is detrimental to the general welfare of camp and other campers. I understand that in such a situation, tuition is nonrefundable. I understand that non-attendance does not entitle me to a refund. I understand that no refunds or adjustments are granted for illness or vacation. I understand that HKS is not responsible for any personal items lost or stolen at our camp HKS does not normally administer any medication and will only do so when requested in writing by the child’s parent or guardian Printed name of Parent/Guardian ________________________________ Signature of Parent/Guardian__________________________________ Date ________________ How did you learn about HKS Horse Camp? ___ Web ___ Friend/Relative ____ Piedmont Parent Other_______________________________________________________