2017 Summer Camp Registration
Camper's Last Name *
Your answer
Camper's First Name *
Your answer
Camp Dates First Choice *
If your child is attending more than one camp, please select all applicable boxes.
Required
Camp Dates Second Choice *
If your child is attending more than one camp, please select all applicable boxes.
Required
Parent Names *
Your answer
Parent Email Address *
Your answer
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.
Your answer
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.
Your answer
Summer Camp T-Shirt Size (included in the cost of camp) *
Additional Summer Camp T-Shirt Size $12/each
Payment Information *
Checks should be made payable to Duzan Riding Academy. You can mail payment to 14191 State Road, Ostrander, Ohio 43061.
Camper's Gender *
Camper's Birthday *
MM
/
DD
/
YYYY
Home Address *
Your answer
Parent Cell Phone *
Your answer
Parent Home Phone
Your answer
Parent Work Phone
Your answer
Emergency Contact 1 Name and Phone Number *
Your answer
Emergency Contact 2 Name and Phone Number *
Your answer
Insurance Company and Policy Number *
Your answer
Physician Name and Phone Number *
Your answer
Dentist Name and Phone Number *
Your answer
Preferred Hospital Name and Phone Number *
Your answer
Allergies, Medical Conditions, Social/Behavioral Issues we should know about
Your answer
Please describe your child's experience with horses. *
Required
Is there a friend your child would like to be paired with if possible?
Your answer
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