Stonegate Farm

2011 Day Camp Registration Form

Camper’s Name___________________________________Age_______

Address____________________________________________________

City_____________________________State________Zip___________

Mother’s Name__________________________email_______________

Address____________________________________________________

City_____________________________State________Zip___________

Phone

Home_______________Work______________Cell________________

Father’s Name___________________________email_______________

Address____________________________________________________

City_____________________________State_________Zip__________

Phone

Home_______________Work______________Cell_________________

Please indicate the week(s) you would like to attend:

1st Choice______________2nd Choice___________3rd Choice__________

____________________________________________________________

Horse/Riding Experience:_______________________________________

____________________________________________________________

Emergency Contact (please provide two names with phone numbers).

Health concerns, allergies, other:__________________________________

____________________________________________________________

I, __________________________, hereby authorize Stonegate Farm to secure medical services for_________________________(my child) if necessary.

Parent’s signature___________________________Date________________

Registration requires a non-refundable $100 deposit for each camp participant.  Please send this form completely filled out with the deposit.

Return to:

Stonegate Farm Summer Camp,  11130 Julianne Ave N.,  Stillwater, MN 55082

If you have any questions, contact Tracy at 651-407-0350 or email stonegate@usfamily.net