Camper Contact & Medical Form

This information will be kept on file. You do not need to resubmit this form for each session registered. Please notify us if any of campers personal information needs to be updated.

Camper Information

Name: Age:

Gender: Male Female

T-Shirt Size:

Riding Experience:

Beginner (little to none)

Novice (walk, posting trot)

Intermediate (walk, trot, canter, small jumps)

Advanced (walk, trot, canter, course of jumps)

Where did you hear about Raynham Stables Day Camp?

Contact Information

Parent/Guardian

Name:

Address: Please include postal code

E-mail:

Home Phone #:

Work Phone #:

Cell Phone #:

Emergency Contact (will only be used if parents cannot be reached)

Name:

Relationship to Camper:

Home Phone #:

Cell Phone #:

Medical Information

Name of Doctor:

Phone #:

Health Card #:

Does the camper have any allergies?

Yes No If yes, please list:

Will he/she carry an epi-pen? Yes No

Will the camper be taking any medications during camp hours?

Yes No (If yes, please send instructions with medications)

Please list any other physical, mental or emotional concerns we should be aware of?

In the course of all program activities, photos may be taken and audio-visual recordings may be made. Raynham Stables reserves the right to use all photographs and videos of all our programs, participants, special events and facilities for promotional purposes. Do you give permission for your child to be a part of our promotional materials? Yes No

This information will be kept on file. You do not need to resubmit this form for each session registered. Please notify us if any of the information needs to be updated.