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Camp Registration Form: Please print clearly Youth Name: ___________________________ Age if under 21: _______ Dates of Camp: ______________________________________________________ Parent/Guardian Name(s): ________________________________________________ Address: ____________________________State: ________ Zip: _____________ Home Tel: _____________ Office: __________________ Cell: _______________ Emergency Contact(s): ____________________ Tel: __________________________ Address: ______________________________State: _________ Zip: ___________ Relationship: _____________________ Phys. Name: _________________________ Phys. Address: ___________________________State: ____________Zip: ________ Phys. Tel: _______________ Hospital Affiliation: ____________________________ Known Medical problems or Allergie(s): _____________________________________ ______________________________________________________________________ In the event of accident or injury I give Treasure Equestrian Community Center, Inc. management and/or staff to seek medical attention for my minor child named above. Date: ___________Signature: ___________________________________________. Printed Name: ________________________________________________________ Youth Interests: Western: __ Showmanship: __ Hunt seat: __ Dressage: __ 2 Phase: ___ Eventing: __ Show Jumping: __ Longlining: __ Rider experience: Beginner: __ Intermediate: __ Advanced: __ Jumping Level: Elementary: __ Pre-novice: __ Novice: __ Training: __ Event Fee: _________________ Amount enclosed: ___________________________ Reserve # of Stalls : ____ Stall Fee: ___________ Amount enclosed: ____________
By placing my signature below I acknowledge that I am registering myself or my minor child for camp and that my registration fees and stall fees are non-refundable. Date: _______________ Signature: _______________________________________
Camper: Please write a brief paragraph below telling us a little about yourself and why you are interested in our program:
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