Summer
Camp Application
Please download file, print, fill out
information, and send by US mail
with $50.00 application fee to the address above.
Please indicate weeks requested:
__________________________________
Name:_______________________________________________________________________
Address:
_____________________________________________________________________
Age: ___________ Height:__________ Weight:________ Grade: __________
Mother’s Name: ________________________________________________________________
Address:______________________________________________________________________
Home Phone: __________________________ Business Phone:_______________________
Business Address:______________________________________________________________
Father’s Name: ________________________________________________________________
Address:______________________________________________________________________
Home Phone: __________________________ Business Phone:_______________________
Business Address:______________________________________________________________
In case of emergency contact:_____________________________________________________
_____________________________________________________________________________
Physician’s Name:_____________________________ Phone:_________________________
Physician’s Address:_____________________________________________________________
Known Allergies:_______________________________________________________________
Comments:____________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
I, ___________________________________, hereby authorize BLACK’ HORSES &
PONIES
to secure medical services for my child _______________________________if necessary.
____________________________________ _______________________
Signature Date
*$50.00 deposit required with application (non-refundable)
DOWNLOAD NOW !!
appnew.pdf
(800k)
In order to view and print out
the application form, you will need
to download Adobe Acrobat Reader
available by clicking on the link below...
Release
I/We ____________________________________________________________, parent(s) or legal
guardian(s) of ________________________________________(child), by enrolling my/our child
in Black’s Horses & Ponies, Inc. Summer Riding Camp, certify that I/we are
cognizant of Florida Statutes 773.04 which states as follows:
"UNDER FLORIDA LAW, AN EQUINE ACTIVITY SPONSOR OR EQUINE PROFESSIONAL IS NOT
LIABLE FOR AN INJURY TO, OR THE DEATH OF, A PARTICIPANT IN EQUINE ACTIVITIES RESULTING
FROM THE INHERENT RISK OF EQUINE ACTIVITIES."
BLACK’S HORSES AND PONIES, INC. AND STAFF REQUIRE OUR SUMMER CAMPERS TO PROVIDE
AND WEAR PROTECTIVE HEADGEAR (HARD HAT) AND BOOTS OR SHOES WITH A HEEL.
I/We hereby release Black’s Horses & Ponies, Inc. and any staff members
affiliated with Black’s Horses & Ponies, Inc. from any responsibility for any
occurrence in connection with the Summer Riding Camp which may result in injury, death, or
other damages.
I/We further state that I/we are of lawful age and competent to sign this affirmation
and release and that by signing I/we understand the terms therein.
I/We assume all responsibility for ______________________________________(child)’s
physical fitness and capabilities to perform under normal conditions of the Black’s
Horses & Ponies, Inc. Summer Riding Camp.
In witness whereof I/we have executed this affirmation and release on this
_____________ day of ___________________, 20_____.
___________________________________ _______________________________________
Parent or Guardian Witness
___________________________________ _______________________________________
Parent or Guardian Witness
DOWNLOAD NOW !!
releasenew.pdf
(600k)
In order to view and print out
the release form, you will need
to download Adobe Acrobat Reader
available by clicking on the link below...
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