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HGMM Camp Registration
Please fill out the following information for the HGMM Camp you would like to register for:
Which camp are you registering for? *
The following camps are for children ages 6-13.
Shirt Size *
Camper's Name *
Your answer
Nickname
What does the camper prefer to be called
Your answer
Gender: *
Date of Birth *
MM
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DD
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Age *
Your answer
Does the camper have any experience with horses? If yes, please describe their experience *
Your answer
Parent/Guardian's Name: *
First and last name
Your answer
Address: *
{please include: City, State, and Zip Code)
Your answer
Phone Number *
What is the best way to reach you?
Your answer
Phone Number
What is the best way to reach you if the first number does not work?
Your answer
Emergency Contact Information *
Please include: Name, phone number and relation to camper
Your answer
Email Address *
Your answer
Would you like to get email updates about HGMM?
How did you hear about HGMM Round-Ups?
Medical Information
All information is confidential and for the protection of the camper.
Camper's Name *
First and Last
Your answer
Doctor's Name: *
Your answer
Doctor's Phone Number *
Your answer
Does this camper have any known allergies? *
List any allergies or health restrictions the camper may have.
Your answer
Is the camper allergic to any antibiotics or medications? *
Your answer
Does this camper have any medical, physical or behavioral problems we need to be aware of? *
Your answer
Last year of Tetanus Shot?
MM
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DD
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YYYY
Name of Insurance Provider *
Your answer
Insurance Provider's Phone Number *
Your answer
Policy # *
Your answer
Group # *
Your answer
Liability Form
I understand that I/my child am undertaking all activities here at Higher Ground Ministries of my own accord and will not hold Higher Ground Ministries, their employees, volunteers, subcontractors, or suppliers liable for any injuries that might occur as a result of me/my child taking part in these activities. By participating in these activities I authorize the use of my/ my child's photograph or likeness, still or motion, at the discretion of Higher Ground Ministries.
Signature: By checking the box, you are giving us the equivalent of a signature and have read and agreed to the liability form above. *
In order to check the box, you must be at least 18 years of age, otherwise your Parent/Guardian is required to sign.
Discounts and Payment
Make checks payable to "Higher Ground Ministry Mission". Please mail checks to: 383 Collins Road, Sebree KY 42455.
If paying by Paypal, an extra 2.9% is required to add to your registration total to cover the amount of transaction fees. Thank you.
Discounts
One discount per person with the except of the ministry discount
Pastor/Missionary Discount option: *
Available for families working with a ministry organization. Please give the name of the ministry you/your family is involved in.
Your answer
Rope in a Friend Discount option:
Please first and last name the camper who you invited or you were invited by to receive the full discount.
Your answer
Are you registering for: *
Are you bringing your own helmet? *
Every child must have an ASTM SCI approved equine riding helmet! If you don't have one, you can rent on for the entire camp for $10.
Are you bringing your own horse? *
Addition cost of $25 for weekend camps or $45 for week-long camps
Payment Options *
How do you wish to pay for camp?
Camp Fee: *
Helmet Rental: $10 *
Please insert payment amount in space below
Your answer
Bring your own horse: *
If Applicable...
Payment Total: *
For Paypal: a 2.9% addition is required to total (including discounts) to cover transaction fees.
Your answer
Discount: *
Enter Discount to total amount.
Your answer
Payment Total with discounts: *
Please do not send payment until the registration and payment total has been verified.
Your answer
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