2023 Dustin's Place Camps
Offering western riding lesson, adaptive riding, therapeutic horseback riding, horse shows and camps to kids and adults with special needs, as well as kids without special needs

Mailing address- 6580 Riley Rd Cumming, GA 30028
Physical address for DAY CAMP- 6737 Concord Rd Cumming, GA 30028

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Email *
Camper Full Name *
Camper Full Address *
Parent/Guardian Name *
Parent/Guardian Cell Number *
Emergency Contact Name *
Emergency Contact Cell Number *
Does your camper have any special needs? If so, please explain. If not, just put NA
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Does your camper have any allergies? If so, please explain. If not, put NA
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Is your camper on any medication? If so, please explain. If not, put NA
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Pick date for Day Camp- Advanced camp must be a current client and be able to tack up and trot alone. Each day camp runs from 9am-1pm, Monday-Thursday and cost $375 per week

Spring Break Camp- Each day of camp will run 9am-1pm and is $90 per day
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Parent/guardian of camper understands and agrees that none of the released parties shall be liable in any way for any occurrence in connection with the released activity in which any of us participate which results in injury, death, or other damages to any of us or members of our family, our heirs or assigns, even if the occurrence is the result of negligence of one of the released parties, unless the occurrence is the result of willful or wanton negligence. Each of us recognizes and appreciates that the released activity is dangerous and that severe injury or possibly death may result to any of us from each of our participation. Each of us understands and appreciates that horses may act in any unpredictable manner and may become overly excited and do injury to any of us. Each of us understands that other riders may be inexperienced, reckless, or may act in an unsafe manner from time to time. Each of us understands and appreciates that the released parties do not guarantee the safeness of the riding ability or habits of any others around whom any of us may be, or the safeness of any of the horses being used in connection with the released activities by any of us or any other around us.
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Required
Under Georgia law, an equine activity sponsor or equine professional is not liable for any injury to, or death of, a participant in equine activities resulting from the inherent risks of equine activities, pursuant of chapter 12 of title 4 of the official code annotated.
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Required
Under Georgia law, there is no liability for an injury or death of an individual entering these premises if such injury or death results from the inherent risks of contracting COVID-19. You are assuming this risk by entering these premises. O.C.G.A 51-16-3
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Required
I agree in the use of individual and group pictures of my camper, to be used by Brecht Stables & Dustin's Place in marketing/promotional material
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Required
How would you like to pay? $700 deposit is due to hold a spot for sleepaway camps and a $100 deposit is due for day camps. ALL deposits are nonrefundable and are used to hold your campers spot in camp. Payment for sleepaway camps are due by May 19th, 2023 and day camps are due the day before day camp starts.
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Parent/guardian electronic signature
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Parent/Guardian electronic date *
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