Saturday Farm Fun Registration

* Indicates required field

What Saturday would you like to register your child? (TJ Stables will confirm with you availability for your chosen day. (Please write month day and then year.) *

Camper's Name *

First

Last

Child's Date of Birth: *

Address *

City *

Postal Code *

Province *

Second Parent/Guardian Name *

First

Last

Email address *

Home Phone Number *

Alternate Phone Number *

Primary Parent/Guardian Name *

First

Last

Parent Email Address: *

Home Phone Number: *

Alternate Phone Number *

Emergency Contact (Not a Parent) Name: *

First

Last

Relationship to Camper *

Emergency Phone Number *

Child's Health Card #: *

Family Doctor: *

Medical Information: Camper's Health If your child has any special needs that require additional support, please provide details. *

List any allergies your child has: *

Consent and Waiver of Liability: (Please read carefully) I desire my child to participate in TJ Stables Summer Camp and all activities unless I advise otherwise in writing. I agree that if my child fails to complete the program, fees will not be refunded. I, the undersigned hereby consent to my child's use of the facilities of TJ Stables at RR7 Chatham, Ontario, knowing there is no warranty as to the fitness or condition of horses and equipment on the premises and on behalf of my child, I hereby release Terry Jenkins, TJ Stables and their employees, as well as the property owners, from any liability, past, present or future in connection with my child's use of the facilities. I understand and agree that TJ Stables shall not be liable for any injuries or property damage, howsoever caused. Should TJ Stables determine that my child cannot keep up to the class, or is at risk or puts others at risk, a worker will be provided by TJ Stables and I agree to pay any additional fees for this service. TJ Stables reserves the right to withdraw a participant for safety or behaviour reasons with NO refund. I am enclosing the required deposit of $100.00, the balance due first day of the program. In the event my child cannot attend the program and an alternate date cannot be arranged, I am aware my deposit of $100.00 will not be refunded. I also give my permission to send my child information and print material informing of future activities or events at TJ Stables. I also give my permission to use any photographs or videos for promotional use *

Yes, I consent to the above waiver.

Today's Date: *

Parent's Name *

First

Last

Submit

* Indicates required field

What Saturday would you like to register your child? (TJ Stables will confirm with you availability for your chosen day. (Please write month day and then year.) *

Child's Name *

First

Last

Address *

City *

Postal Code *

Province *

Child's Date of Birth: *

Home Phone Number: *

Emergency Phone Number *

Work Phone Number *

Cell Phone Number *

Parent Email Address: *

Child's Health Card #: *

For questions 1- 4, if they do not apply to your child please type n/a.

Family Doctor: *

1. Does your child have any health problems or special needs? If yes, please describe. *

3. Does your child have medical or behavioural issues? If yes, give details. *

2. Does your child have any allergies? (Please provide details (dust, food, insect bites, repellent etc. and treatment required: *

4. Does your child require any assistance or medication at school? *

Yes, I consent to the above waiver.

Today's Date: *

Parent's Name *

First

Last

Submit

Saturday Farm Fun Registration

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