Contact Numbers:

Home:   Work: 

Cell:      Other:

Email: 

Emergency Contact

Name:

Relationship:

Home: Work: 

Cell:    Other:

Insurance Information:

Company:   Phone:

Policy Number: Group/ID Number:

Special Needs:

Please inform us of any special needs, allergies, or any other pertinent information about this camper/rider:

I (we) are registering for:  Camp Lessons - Lesson Dates

              2006 Summer Camps (Please check sessions you would like to attend)

             Session 1: Full Day (9:00 AM-3:00 PM ) week of 06/05/06   

             Session 2: Half Day (9:00 AM-12:00 PM) week of 06/12/06 

             Session 3: Full Day (9:00 AM-3:00 PM ) week of 06/19/06   

             Session 4: Half Day (9:00 AM-12:00 PM) week of 06/26/06 

A $80.00 deposit is required to reserve camp spot for a full day

(9:00 AM - 3:00 PM) week session. 

A $70.00 deposit is required to reserve camp spot for a half day

(9:00 AM - 12:00 PM) week session

Camp must be paid in full 1 (one) week prior to camp start date.

I (we) will pay by  Cash Check Paypal MC/VISA

Payment date:

RELEASE:

Bridlewood farms, it’s owners, officials, employees and agents, will not be responsible for any accident or loss which may occur to any camper, guest, attendant, or other employee, animal or equipment at this camp, or while on the grounds.   It shall be a condition of every camper that you shall hold Bridlewood Farms harmless for any illness, loss or accident that may occur.

By signing this, you agree to these terms to participate. You also give us permission if we are unable to contact you, to call 911 for any medical emergency.

I agree to these terms

Name: Date:  

You will be asked to sign a hard copy of this agreement for our files upon commencement of your first lesson or camp week.