REGISTRATION FORM Spring 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 #_____________________

CAMP SESSION Fee is $60 per day/$275 for week. Payment must be received in full to ensure reservation.	March 16-20, 2009	9am - 5pm
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.

© 2010 Capricorn Equestrian Center
6101 Ben Road
Sachse, TX 75048
(972) 530-1124
Chad Easterling, Owner
(972) 839-2721
Email