REGISTRATION FORM October Camp
NAME (last) ____________________(first)______________________BIRTHDAY_________
ADDRESS_____________________________CITY___________________ZIP___________
PARENT OR LEGAL GUARDIAN________________________________________________
HOME PHONE #_____________________WORK PHONE #_________________________
EMAIL______________________________________________________________________
EMERGENCY CONTACT__________________________PHONE #____________________
NAME OF PERSON(S) ALLOWED TO PICK-UP CHILD:
____________________________________DRIVERS LICENSE #_____________________
____________________________________DRIVERS LICENSE #_____________________
____________________________________DRIVERS LICENSE #_____________________
| CAMP SESSION (circle any that apply) | FEES | ||
| TBD | $45/day per child | ||
| TBD | $45/day per child | ||
| TBD | $45/day per child | ||
| TBD | $45/day per child | ||
| TBD | $45/day per child | ||
| Amount Enclosed:____________ | Check Money Order Credit Card | ||
Signature: _____________________________________Date:______________ |
|||
| If paying by Credit Card
select one: Visa MasterCard
Discovery American
Express
Name:____________________________ Card # __________________________ExDate:_____ Amount to be Charged: $_________ Signature:_______________________________________ |
Mail form and tuition payment (check or money
order made out to Capricorn Equestrian)
to: Capricorn Equestrian, 6101 Ben Road, Sachse, Tx 75048.