Holiday Camp Registration Form

Camp Date(s). Hours: 9-3. * PLEASE NOTE: We must have a minimum of 5 campers each holiday to run camp * * PLEASE NOTE: For Spring Break and Summer camps, please use different link. *

Current Total:

$0.00

Extended Care Needed @$15/hour (Available 3-5 pm. Please list times. Pay at barn on camp day.)

Rider Information

First Name *

Last Name *

Preferred Name

Age *

Date of Birth *

Height

Weight

Allergies

Restrictions

Permission to give the following (check all that apply) *

Doctor Name *

Phone *

Insurance Name *

Phone *

Member Number *

Group Number *

Riding Experience

Please select the following experience levels for each activity *

	Never	Working On	Mastered
Walk	Never	Working On	Mastered
Trot	Never	Working On	Mastered
Canter	Never	Working On	Mastered
Cross-Rails	Never	Working On	Mastered
18" Jump Course	Never	Working On	Mastered
2' Jump Course	Never	Working On	Mastered
2'6" Jump Course	Never	Working On	Mastered

Years of Riding Lessons *

Lessons Per Month *

Years of Riding Camps *

Camps Per Year *

Description of temperament *

Friends in Camp

Goals for Camp

Parent / (Spouse) Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Emergency Contacts

Name *

Relationship *

Phone Number *

Name

Relationship

Phone Number

Release Waivers

Liability Waiver

I have read the above Liability Waiver and agree to the terms for the child listed above and the camp dates selected. *

Yes

I give permission for my child's picture to be used for Red Gate Farm promotional material. *

Yes

I give permission for Red Gate Farm's Summer Camp program to seek medical treatment, if necessary. *

Yes

Name *

Date *

Signature *

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Monday, Sept. 25, 2023 $150	Monday, Oct. 09, 2023 $150
Monday, Oct. 30, 2023 $150	Tuesday, Oct. 31, 2023 $150 Halloween fun
Tuesday, Nov. 7, 2023 $150	Monday, Nov. 13, 2023 $150
Monday, Jan. 15, 2024 $150	Monday, Jan. 22, 2024 $150
Monday, Feb. 19, 2024 $150	SUNDAY, FEB 18, 2024 SLEEPOVER $150
Tuesday, March 5, 2024 $150	Friday, April 5, 2024 $150
Wed., April 10, 2024 $150