Camp Registration Form

In order to complete your on-line registration, you'll need a credit card for payment. If you would rather pay by cash or check, you can register in person at the Stables.

Camp:	View scheduled camps
Child First Name:
Child Last Name:
Age:
Date of birth:
Sex:
Address:
Address:
City:
State:
Zip:
Email:
Mother's Name:
Mother's Home Phone:
Mother's Work Phone:
Mother's Cell Phone:
Father's Name:
Father's Home Phone:
Father's Work Phone:
Father's Cell Phone:
Riding Experience:
Allergies:	(Medications, Foods, Bee Stings, Dust, Weeds, etc.)
Medications:	List only those that will be sent with camper, list how they are to be administered and any side effects. PRESCRIPTIONS MUST BE IN THE ORIGINAL PACKAGE WITH THE NAME OF THE CHILD AND DOSAGE PRINTED ON THE LABEL
Often children request Tylenol. May Paradise Stables LLC or Paradise Stables Too, LLC give your child the recommended dosage of Children’s Tylenol? :	Check the box below if you authorize Paradise Stables, LLC or Paradise Stables Too, LLC to administer the above named medication to my/our child.
Pertinent Health Problems:	(Heart murmur, Diabetes, Asthma, Seizures, etc.)
Date of Last Tetanus Shot:	(Must have this date or registration will not be completed)
Doctor's Name:
Doctor's Phone:
Insurance:
Physical or Mental Disability?	Check the box if your child has any physical or mental disability, medical conditions, or behavioral problems we should be aware of?
Please explain if your child has any physical or mental disability, medical conditions, or behavioral problems:
If we cannot contact you in case of emergency, whom should we contact?
Phone number for the above contact:
INFORMATION OF ADDITIONAL PERSONS AUTHORIZED TO PICK UP CHILD DAILY: These names also need to be contacts for emergency pick-up if you cannot be reached. Photo ID will be required.:
Name:
Phone:
Name:
Phone:
Name:
Phone: