Week 2 Little Horse Lovers Camp 6/6-6/10/22

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Ages 5-7

Camper's Last Name *

Camper's First Name *

Camper's Birthday *

YYYY

Camper's Age at Time of Camp *

Campers must be a minimum of 5 years old at the time of camp to attend. No exceptions.

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

Please describe your child's experience with horses. *

Regular weekly lessons

DRA Camp

Summer camps at other facilities

Trail riding or Pony rides

No Prior Experience

Required

Payment Information *

Checks should be made payable to Duzan Riding Academy. You can mail payment to 14191 State Road, Ostrander, Ohio 43061.

I will mail/drop off a check upon registration.

Zelle / Chase Quickpay

Venmo

Parent 1 Name and Cell *

Parent 2 Name and Cell

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

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