Waiting List Only Due to Covids limits / Waiting list for Girls Aged 10+ , Intermediate +
Which camp will your child be attending? Cost of JHC $185 *
First Name *
Last Name *
Clear selection
Age ? *
Date of Birth *
Are you Hiring or Bring your own Horse
Clear selection
What is your child's riding ability? *
Which horses has your child previously ridden at camp?
(complete only if your child has attended a Lakes Ranch horse camp previously, with the use of a Lakes Ranch horse)
A friend attending camp that they would like to be in a cabin with?
please note we cannot confirm that your child will be grouped with these campers
Address *
Street Number
Address *
Street Name
Address *
Address *
Address *
Parent/Guardian *
Parent/Guardian *
Email Address
Parent/Guardian *
Home Phone Number- Please include area code
Parent/Guardian *
Work Phone Number
Parent/Guardian *
Mobile Phone Number
Emergency Contact Name *
Please provide details for a person we can contact should we not be able to contact you in the event of an emergency. We will require the contact's name, phone number, mobile number (if available) and their relationship to the child.
Emergency Contact *
Home Phone Number- Please include area code
Emergency Contact *
Mobile Phone Number
Any allergies your child has
ie. Food, Animal or Plant allergies
Any Medical conditions your child has
ie. Asthma, Diabetes
Any disabilities or behavioral conditions - please explain
Any medication your child needs during camp
Note: all medication including panadol and antihistamines will need to be handed in
Permission for Lakes Ranch to administer paracetamol, panadol or ibuprofen? *
Lakes Ranch may provide these medications if necessary for the comfort of your child
Does your child have any other needs we should be aware of? This may include GF, DF etc
Please supply milk if DF. Also supply baking for DF, GF with your. Supply Bread if GF. Please put your Childs name on items.
Is there anyone who is not allowed access to your child?
If yes, please provide names in the space provided.
Will an agency be supporting your child if so we require an O/N to proceed with invoicing. State Agency and O/N.
Who will be picking up your child from camp? *
If this is to change you must notify the camp before camp finishes
Do you consent to your child being sent follow-up information and studies by Lakes Ranch? *
Payment Details *
Please make sure all relevant information is enclosed above. The attendees camp fees to be paid online, please use the reference "JHC" for camper "Surname" and "Month of Camp". A non-refundable $100 deposit is required on acceptance. Full fees required 2 weeks prior to Camp.. Eftpos is not available. Please note we do not currently offer OSCAR funding..
Declaration by Parent/Caregiver (signature will be required at sign-in) *
1. I consent to all the information supplied in this form being used for the purpose of running the camps and agree that my child will abide by camp rules. 2. In the event of sickness or accident I authorise that qualified medical attention be secured and notification followed by any expense to me at the above address. 3. I agree that staff and Leaders will be clear of all liability in the event of any injury or loss which the camper may sustain to person or property.
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