Intermediate Summer Camp July 12

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Intermediate Summer Camp July 12 - 16

Camper's Last Name *

Camper's First Name *

Camper's Birthday *

YYYY

Camper's Age at Time of Camp *

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

Do you need before or after camp care? *

Yes

What days and time do you need before camp care?

Before care is available 8:00-9:00, Monday-Friday. Please specify days of the week and times below.

What days and time do you need after camp care?

After care is available 2:00-4:00, Monday-Thursday. Please specify days of the week and times below.

Is there a friend your child would like to be paired with if possible?

Please describe your child's experience with horses. *

Regular weekly lessons

Participated in a DRA Camp

Participated in summer camps at other facilities

Jumping Experience - Crossrails

Jumping Experience - 2'

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 Names *

Parent Email Address *

Home Address *

Parent Cell Phone *

Parent Home Phone

Parent Work Phone

Emergency Contact 1 Name, Relationship, Phone Number *

Emergency Contact 2 Name, Relationship, and Phone Number *

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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