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
Submit
Never submit passwords through Google Forms.
This form was created inside of duzanridingacademy.com. Report Abuse - Terms of Service - Additional Terms