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Horsemanship Summit Registration Form
Please fill out the following form for Higher Ground Ministry's Horsemanship Summit
Shirt size: *
Camper's Name: *
First and Last
Your answer
Nickname:
The name camper most commonly answers to
Your answer
Gender: *
Date of Birth *
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DD
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YYYY
Age: *
Your answer
Parent/Guardian's Name: *
First and Last
Your answer
Home Address *
Your answer
Phone Number: *
Home
Your answer
Phone Number:
Mobile
Your answer
Emergency Contact information: *
Name, phone number, and relation to camper
Your answer
Email address
Your answer
I would like to receive email updates about HGMM:
Please explain your experience around horses: *
Your answer
How did you hear about HGMM programs?
Are you bringing your own horse? *
Extra cost of $45 for a week-long camp.
Are you registering for: *
Helmet Rental ($10) *
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.
Medical Information
Name: *
First and last
Your answer
Doctor's Name *
Your answer
Doctor's Phone Number *
Your answer
Does this camper have any known allergies? *
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 Tetanus Shots
MM
/
DD
/
YYYY
Name of Insurance Provider *
Who is your health 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 are agreeing to the above liability form. *
In order to check the box, you must be older than 18, otherwise your Parent/Guardian is required to sign.
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