Intermediate Summer Camp July 12 - 16
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Camper's Last Name *
Camper's First Name *
Camper's Birthday *
Camper's Age at Time of Camp *
Camper's Gender *
Summer Camp T-Shirt Size (included in the cost of camp) *
Do you need before or after camp care? *
What days and time do you need before camp care?
Before care is available 8:00-9:00, Monday-Friday. Please specify days of the week and times below.
What days and time do you need after camp care?
After care is available 2:00-4:00, Monday-Thursday. Please specify days of the week and times below.
Is there a friend your child would like to be paired with if possible?
Please describe your child's experience with horses. *
Payment Information *
Checks should be made payable to Duzan Riding Academy. You can mail payment to 14191 State Road, Ostrander, Ohio 43061.
Parent Names *
Parent Email Address *
Home Address *
Parent Cell Phone *
Parent Home Phone
Parent Work Phone
Emergency Contact 1 Name, Relationship, Phone Number *
Emergency Contact 2 Name, Relationship, and Phone Number *
Insurance Company and Policy Number *
Physician Name and Phone Number *
Dentist Name and Phone Number *
Preferred Hospital Name and Phone Number *
Allergies, Medical Conditions, Social/Behavioral Issues we should know about
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