Lakes Ranch Junior Horse Camp Registration Form
Which camp will this camper be attending? *
First Name *
Your answer
Last Name *
Your answer
Gender
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Address *
Street Number
Your answer
Address *
Street Name
Your answer
Address *
Suburb
Your answer
Address *
Town/City
Your answer
Address *
Postcode
Your answer
Parent/Guardian *
Name
Your answer
Parent/Guardian *
Home Phone Number- Please include area code
Your answer
Parent/Guardian *
Work Phone Number
Your answer
Parent/Guardian *
Mobile Phone Number
Your answer
Parent/Guardian *
Email Address
Your answer
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.
Your answer
Emergency Contact *
Home Phone Number- Please include area code
Your answer
Emergency Contact *
Mobile Phone Number
Your answer
Any allergies your child has
ie. Food, Animal or Plant allergies
Your answer
Any Medical conditions your child has
ie. Asthma, Diabetes
Your answer
Any disabilities or behavioral conditions - please explain
Your answer
Any medication your child needs during camp
Note: all medication including panadol and antihistamines will need to be handed in
Your answer
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?
Please specify
Your answer
Hire a Lakes Ranch horse or bring their own? *
If your child is bringing their own horse, please include when it was last drenched
Required
What is your child's riding ability? *
Required
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)
Your answer
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
Your answer
Is there anyone who is not allowed access to your child?
If yes, please provide names in the space provided.
Your answer
Does your child receive support from any of the following agencies?
If yes, please select as many as are relevant.
Who will be picking up your child from camp? *
If this is to change you must notify the camp before camp finishes
Your answer
Do you consent to your child being sent follow-up information and studies by Lakes Ranch? *
Payment Details *
PLEASE NOTE THE DEPOSIT IS TO CONFIRM YOUR CHILDS PLACE: The attendees camp fees will be paid by (if bank deposit please use the reference "JHC" for camper "Surname" and "Month of Camp"). A non-refundable $50 deposit before we can confirm your child's place in horse camp. You can pay either by cash, cheque, credit card, or online prior to Camp. Please note eftpos is not available.
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.
Required
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