2024 Camp Registration Form

2024 Camp Dates

Camp Date(s), If camp is FULL, please call / email for options *

SPRING BREAK CAMP March 25-29	FULL *** June 17-21 (Horse Day Camp)
FULL * June 17-21 (Advanced Sleepaway) *	FULL *** June 24-28 ( Horse Day camp)
June 25-28 (4-day Preschool camp)	FULL * July 8-12 ( Advanced Sleepaway camp) *
July 8-12 (Horse Day Camp)	July 15-19 (Horse Day camp)
July 22-26 (Horse Day Camp)	FULL *** July 22-26 (Advanced Sleepaway Camp)
July 29-Aug. 2 (Horse Day Camp)	August 5-9 (Horse Day Camp)
FULL *August 5-9 (Advanced Sleepaway Camp) *	August 12-16 ( Horse Day Camp)
August 13-16 (Preschool Camp)	FULL *** ADULT CAMP JUNE 13-15 (Th-Sa, 6-8:30 pm)
ADULT CAMP AUG 15-17 (Th-Sa, 6-8:30 pm)

Registration Fee (Once per Year Only) *

Registration Fee

Multi-Week Discount *

Is this your second child registered for the same week of camp? *

Yes

No

Current Total:

$0.00

Extended Care Needed (avail 3-5pm) $15/hour one child. $25/2 children. Must be reserved and prepaid on first day of camp.

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 rider's temperament

Friends in Camp

Goals for Camp

Parent / Guardian / 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 rider listed above and the camp dates selected. *

Yes

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

Yes

I give permission for Red Gate Farm's Summer Camp program to transport the rider to field trips (if any) and to seek medical treatment, if necessary. *

Yes

Name *

Date *

Signature *

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Enter the word in the image *
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1 Week (No Discount)	2 Weeks
3 Weeks	4 Weeks
5 Weeks	6 Weeks
7 Weeks	8 Weeks