Week 9 My Own Horse Camp: 7/25-7/29/22

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Ages 8-16

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

Before Care Reservation

Before Care must be paid for at the time of registration in order to reserve a spot. If it is not paid for, there may still be spots available but we cannot guarantee your child will get one. Cost for before care is $20 per day and is from 8:00-9:00 a.m. Please add on the proper amount to your camp payment.

Mon

Tues

Wed

Thur

Fri

After Care Reservation

After Care must be paid for at the time of registration in order to reserve a spot. If it is not paid for, there may still be spots available but we cannot guarantee your child will get one. After care is not available on Fridays. Cost for before care is $40 per day and is from 2:00-4:00 p.m. Please add on the proper amount to your camp payment.

Mon

Tues

Wed

Thur

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 Phone *

Parent 2 Name and Cell Phone

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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