Lakes Ranch Senior Horse Camp Registration
Last Name *
Your answer
First Name *
Your answer
Gender *
Which camp will this camper be attending? *
Registration $345 (includes horse hire) or $275 (excludes horse hire)
Age *
Your answer
Street Number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Street Name *
Your answer
Suburb *
Your answer
Town/City *
Your answer
Postcode *
Your answer
Parent/Guardian *
Name
Your answer
Home Phone *
Please include area code
Your answer
Work Phone *
If applicable
Your answer
Mobile Phone *
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
Your answer
Please note any allergies your child has
ie. Food, Animal or plant allergies
Your answer
Please note any medical conditions your child has
ie. Asthma, diabetes
Your answer
Please note any disabilities or behavioral conditions that may require special care
Your answer
Do you give permission for Lakes Ranch to administer paracetamol, panadol or ibuprofen? *
Lakes Ranch may provide these medications if necessary for the comfort of your child
Please specify any medication your child will need to take during camp
Note: all medication including panadol and antihistamines will need to be handed in
Your answer
Does your child have any other needs we should be aware of?
Please specify
Your answer
Will your child hire a Lakes Ranch horse or bring their own? *
Required
Which horses has your child ridden previously?
(complete only if your child has attended a Lakes Ranch horse camp previously, with the use of a Lakes Ranch horse)
Your answer
Riding Ability? There is only a waiting list for this camp unless you are a Advanced rider or have your own horse. *
Does your child have any friends 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 *
The attendee's camp fees will be paid for by: (if bank deposit please use reference "SHC" for camper or 'L" for leader and "Surname" and 'Month of Camp"). A non-refundable $100 deposit must be paid before before we can confirm your child's place at Horse Camp. You can pay either by cash, cheque, credit card (or online prior to camp starting).
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 expenses sent 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. I also agree to pay for any damage incurred by my child to any Lakes Ranch property, by either accident or malicious intent. 4. I consent to photos and video being taken at camp for promotional and advertising purposes. 5. I acknowledge that the $100 deposit is non refundable.
PLEASE NOTE $100 NON REFUNDABLE DEPOSIT WILL SECURE PLACE, REGISTERING ONLY DOES NOT SECURE PLACE. THANK YOU.
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