TJ Stables Summer Camp Registration

Summer Camp Registration 2019

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Please select from the drop down menu the camp you wish to register your child in: *

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

Summer Camp Registration 2019

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