Enrollment Form

Camper's Name: ____________________________________Age during camp: _________Height: __________

Weight: __________School grade next fall: __________Session Number: ________Dates of Enrollment:
_________________
Father's Name: _________________________Occupation: _____________________________
Mother's Name: _________________________Occupation: _____________________________Camper's Home
Address:_______________________________________________________________
City: _________________________________State: ________Zip Code: ___________
Email Address:________________________________________________________________________
Home Phone: (______ )______ -_________Work Phone: (______ )______ -_________In case of emergency and parent
or guardian cannot be reached, call :_________________________
Relative or Friends Name: ____________________________________________
Phone: (______ )______ -_________
Address:____________________________________________________________________________
Is enrollee covered by family health and accident insurance? Insurance Company's Name:
_____________________________
Card Number: ________________Will you bring your own riding helmet? ________English Saddle/Western Saddle?
________
Briefly describe your child's riding experience:
____________________________________________________________________________________________
If while at camp our child should become ill or have an accident requiring medical attention, the directors have our full
permission to take whatever action they deem necessary, and to authorize appropriate medical treatment (every effort
will be made to contact the parents). We agree that we are responsible for any and all medical expenses incurred. We
hereby give our permission for our child to take part in all camp activities. We have read the camp brochure and camp
policies on this form and agree to all the terms and conditions therein. In riding, as in any active sport, there is
necessarily a certain unavoidable amount of risk. All animals are unpredictable to some degree, and while Champion
Crest exercises care in the selection, training, and use of its horses, it is not possible to guarantee the behavior or actions
of any horse at all times in all situations. Therefore neither Champion Crest nor its employees can make, or have
attempted to make, any representations concerning the specific characteristics, habits, temperament, or behavior of
any horse. In consideration of our child being permitted to enroll as a camper at Champion Crest Horse Camp we fully
and completely release and discharge Champion Crest and its owners and employees, from any and all claims that either
we or our child might have for damages or injuries arising from use of or working with horses, or from any other camp
activities, and we agree to indemnify Champion Crest, Inc. from any such claims made by or on behalf of our child.
*Parent Signature: ______________________________________Date: _______________*Parent Signature:
______________________________________Date: ______________