REGISTRATION FORM Summer 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 DESIRED Fee is $200 per session. Payment must be received in full to ensure reservation.	1st Dates:____________ 2nd Dates:____________ 3rd Dates:____________	Alt 1:____________ Alt 2:____________ Alt 3:____________
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.