CAMP / WORKSHOP APPLICATION

PRINT THIS PAGE COMPLETE AND SEND TO VALERIE GARDNER 220 WAWA RD WAWA PA. 19063 WITH DEPOSIT.

NATURE/PONY CAMP AT RATTLEBOX NATURE CENTER LTD. MAY 26TH THROUGH SEPT 5TH .MONDAY THROUGH FRIDAY 10am. to 1pm. ACT QUICKLY ONLY 6 CHILDREN ACCEPTED PER WEEK.FULLY INSURED.
AVERAGE AGE OF CAMPERS IS 4-9 YEARS

NAME(S)



AGE(S):

ADDRESS:

MOTHER'S NAME:

FATHER'S NAME:

PHONE NUMBERS:

HOME:

CELL:

WORK:


EMAIL:

ALLERGIES:

MEDICATIONS CURRENTLY TAKING:

CAMP RUNS FOR 13 WEEKS, COME FOR ANY # OF WEEKS.


COME BY THE WEEK. RETURN THIS FORM WITH NONREFUNDABLE CHECK FOR $250. FOR FIRST CHILD AND $225. FOR SIBLINGS. RESERVE OTHER WEEKS AND PAY FOR THEM BY WEDNESDAY THE WEEK BEFORE.RESERVE THIS WEEK:


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AND ANY OTHERS:---------------------






WE ARE FLEXIBLE. TIME MISSED CAN BE MADE UP DURING THE SUMMER.
PLEASE WEAR LONG PANTS AND BOOTS TO RIDE. BRING A BIKE HELMET OR RIDING HELMET.BRING SHORTS AND SNEEKERS TO CHANGE INTO AFTER RIDING AND DON'T FORGET YOUR LUNCH!
RELEASE FOR RIDING
Waiver for Rattlebox Nature Center LTD

I, the undersigned, am fully aware that riding a horse is a potentially hazardous activity and I assume the risk of riding Valerie Gardner’s horses and any and all risks, such as falls, contact with other riders and horses, and the effects of uneven ground, associated with riding these horses. All such risks being known and appreciated by me as a consequence of my knowledge and understanding of the above facts, I hereby, for myself and my heirs, executors ,administrators, and anyone else who might claim on my behalf, covenant not to sue Valerie Gardner, or any of the landowners adjacent to their property in Wawa,
Pennsylvania.

Signature of parent or adult/date

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Print name of parent or adult


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Print name of child rider_(s)


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