Week 9 Beginner DRA Students Only Camp July 29

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Week 9 Beginner DRA Students Only Camp July 29 - August 2, 2024

Email *

Camper's Last Name *

Camper's First Name *

Camper's Birthday *

YYYY

Camper's Age at Time of Camp *

Camper's Grade 2024-2025 *

Camper's Gender *

Male

Female

Prefer not to say

Summer Camp T-Shirt Size (included in the cost of camp) *

Child Small 6/8

Child Medium 10/12

Child Large 14/16

Adult Small

Adult Medium

Payment Information *

Payment must be completed upon registration. Registrations that have been filled out but not paid by the end of each day will be deleted and the spot will be opened back up.

Checks should be made payable to Duzan Riding Academy.

Zelle (info@duzanridingacademy or (614) 271-2732

Venmo (@duzanridingacademy / Molly Wirtz)

Check

Zelle

Venmo

Parent 1 Name and Cell Number *

Parent 2 Name and Cell Number

Parent Email Address *

Home Address *

Emergency Contact 1 Name, Relationship, Phone Number *

(Other than parents. Parents will be contacted first in the event of an emergency.)

Emergency Contact 2 Name, Relationship, and Phone Number *

(Other than parents. Parents will be contacted first in the event of an emergency.)

Insurance Company and Policy Number *

Physician Name and Phone Number *

Dentist Name and Phone Number *

Preferred Hospital Name and Phone Number *

Allergies, Medical Conditions, Social/Behavioral Issues we should know about

Notes or Questions *

A copy of your responses will be emailed to the address you provided.

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