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Summer Camp Enrollment Application
Camper Information
* Camper's Full Name:
* Date of Birth:
* Street Address:
* City:
State:
* Zip:
* Insurance Company:
* Phone Number:
Mother's Information
* Mother's Name:
* Street Address:
* City:
State:
* Zip:
* Home Phone:
* Work Phone:
Cell / Mobile Phone:
Occupation:
Work Hours:
Father's Information
* Father's Name:
* Street Address:
* City:
State:
* Zip:
* Home Phone:
* Work Phone:
Cell / Mobile Phone:
Occupation:
Work Hours:
Camper Details
Religious Preference:
Height:
Weight:
Grade:
Riding Experience:


Special Interest(s):


Special Need(s):


Other Camp(s) Attended:
* Session Preference
WEEK ONE MAY 31 - JUNE 6 Campers attending one week only must attend week one or week five
WEEK TWO JUNE 7 - 13 For campers attending two or more weeks
WEEK THREE JUNE 14 - 20 For campers attending two or more weeks
WEEK FOUR JUNE 21 - 27 For campers attending two or more weeks
WEEK FIVE JUNE 28 - JULY 4 Campers attending one week only must attend week one or week five
I certify that the above information is true and correct to the best of my knowledge. I also certify that I am the parent and/or legal guardian of the above named child and that my child wants to attend the St. John Ranch and Lodge Summer Camp. I agree that the child listed above will cooperate fully with all camp rules. By signing below, I give authority to St. John Ranch and Lodge full permission for emergency medical care if sound reason and the facts indicate that it is necessary.
*Signature:    *Your Email Address:    Date: 01/05/2009
APPLICANT AUTHORIZATION: BY MY SUBMITTING THIS FORM ACCEPT AS NOTICE IN WRITING OF AND AGREE THAT I WILL BE HELD FULLY RESPONSIBLE FOR ANY AND ALL MEDICAL BILLS FOR THE ABOVE NAMED CHILD IN CASE OF EMERGENCY
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