Horse Day Camp
Winter 2011 ~ Registration Form
[   ]December 19 ~ 23
Dates are subject to change
Mail your completed registration form
along with a $100 (non-refundable deposit) to:
Darcy Edwards Training Center
Attn: Horse Day Camp Registration
11135 Moreno Ave
Lakeside, CA 92040
Camper’s Name:
Last ____________________
First _____________________		 [] Boy
Birth date ____________
[] Girl

Street Address:

 

 City, State, Zip:

Home Telephone:

 Mobile Telephone:
 Other Telephone:

Father’s Name:

 

 Daytime Telephone Number(s):

 Mother’s Name:

 

 Daytime Telephone Number(s):

Custodial Parent:

 

 [] Both Parents [] Father [] Mother [] other
$100 non-refundable deposit (per session) is due with the enrollment form.
[] $300 - one week (Monday-Friday) 9 AM to 2 PM
 Amount of payment enclosed $ __________
 
I agree to read and understand all registration information - including: health form requirements, liability release form, waiting list/reservation information, and cancellation policy. I certify under the penalty of perjury that my son/daughter has no medical limitation which would impair his/her ability to perform the lessons specified in this day camp. If your child has any impairments or limitations a health care verification form must be filed.

Signature(s):

 

 Date: