Camp registration forms
Campers - print and fill out
- A waiver suitable for their age
- Camp registration form
Rider Information
First Name: Last name:
Week(s) of camp you are registering for ____________________________________ Half or Full Day Camp
Amount Paid: _______________
Birth Date:
Parent Contact Name :
Work /or cell# : Telephone:
Rider Medical Information Health Card #:
Physician Name: Tel#: Emergency Contact Name : (other than above)
Please advise of any medical conditions, ie. asthma, allergies, ADD, other. Do you carry and Epi- pen. Have you or your child received any psychological/psychiatric/family therapy in the last 12 months? Are you or your child currently taking any medication? Please note that all medications should be forwarded to the Camp Director with full doctor's instructions. Under NO circumstances should a child carry his/her medication unsupervised.
Does your child suffer from back problems? Yes /No (circle one)
Does your child suffer from neck pain? Yes / No( circle one )
Are you pregnant ? Yes /No (circle one) If you become pregnant at a later date I agree that I will tell my instructor.
Please give any details of any heatlh problems that you may affect your riding.____________________________________________________________
_________________________________________________________________ Medical/Release Form The rider/camper and/or his/her parent(s) and/or guardian(s) hereby acknowledge the risks and hazards inherent in riding and working around animals, not to be limited to: horses, chickens, dogs and cats and agree to assume all responsibility and risk of bodily injury or damage to property and further agree to hold harmless and indemnify Corner Stone Farm and its owners, employees, volunteers, agents, and representatives from all claims for any bodily injury to persons or damage to property arising out of or resulting from the camper's use of Corner Stone Farms’ premises or use of horses at or from Corner Stone Farm , as a rider, groom or spectator or otherwise in any type of Corner Stone Farms organize, sponsored, supported or endorsed activity, whether on Corner Stone Farm premises or elsewhere, and including transportation provided Corner Stone Farm or the individuals or organizers referred to herein. The camper and his/her parent(s) and/or guardian(s) do hereby consent to any medical examination, treatment or medical services that may be rendered to said camper under the general or specific instructions of any physician or hospital. It is understood that this consent is given in advance of any specific diagnosis or treatment. The camper and the undersigned parent(s) and/or guardian(s) agree to assume responsibility for payment of all fees for doctors, hospitals, ambulances and/or other medical charges reasonably and necessarily incurred. Insurance is the responsibility of the rider/camper and/or his/her parents. The camper and his/her parent(s) and/or guardian(s) do hereby consent that photos/images of the camper/rider may be used in Corner Stone Farm’s articles and advertisements without payment or remuneration to that said camper/rider. I agree to inform Cathy Colwell and/or Corner Stone Farm if any of the above details change. I agree to abide by all the rules of Corner stone Farm while I am a client of the above establishment. Deposit and camp fee agreement deposit of 50% of the camp fee is to be attached with your registration form. Any incomplete forms will not be accepted. If you have any questions about filling out the forms please contact Cathy.
Please note that the balance of camp fees must be received no later than week before the first day of your child's camp session. Camp fees are non-refundable after this time.
Cheque made out to Cathy Colwell
Should you need to withdraw your child from camp, arrangements can be made to credit your child for an alternate camp session during the current season (subject to availability and discretion of camp director). All deposits are non-refundable.
Signature:__________________________________
Print name: ______________________________________Date:________________ Parent or Guardian signature if client is a minor __________________________
