Application For Pause Awhile Summer Camp 2016

APPLICATION FOR PAUSE AWHILE SUMMER CA M P 2016

CAMPER

Full Name: ___________________________________________________ Date of birth: ____/____/____ (mm/dd/yy)

Address: _______________________________________ City: _______________________ Postal Code: _________

Have you ridden before? Yes ____ No ____ How many years? _____ Where?: _____________________________

Ability: Walk___ Trot___ Canter___ Jump___ Briefly describe your interests and abilities: _____________

__________________________________________________________________________________________ ______

Do you have any fears pertinent to camp – animals, water, etc? __________________________________________

Are you able to swim in the deep end of a pool? Yes____ No____

How did you find out about our camp? Current student____ Website____ Friend____ Other________

MEDICAL

Family doctor: _____________________________ Tel: _____________ Health Card #: ________________________

Do you have any medical needs that we should be aware of (please provide details)? __________________________

_________________________________________________________________________________________________

Do you require any medication that we should be aware of (please provide details)? __________________________

SESSION

Select session #: 1 st choice ___________ 2 nd choice ________ #1 Jul 4 – Jul 15 $650.00 + HST

(All sessions are from 9:00 a.m. to 4:00 p.m.) #2 Jul 18 – Jul 29 $650.00 + HST

#3 Aug 1 – Aug 12 $650.00 + HST

#4 Aug 15 – Aug 26 $650.00 + HST

#5 Aug 29 – Sept 2 $325.00 + HST

**Save $25.00 when you sign up for two sessions**

Do you need extended hours? Yes _______ No ________ $10.00/Hour + HST

Do you need to rent a helmet? Yes _______ No ________ $15.00 + HST

If you wish to register your child for more than one session, a separate application and deposit cheque is required.

PARENT/GUARDIAN

Full Name: ___________________________________________ E-mail: ______________________________________

Home Tel: ______________________ Cell: ______________________ Work Tel: ______________________________

Emergency contact: __________________________________ Relationship: _________________ Tel: ______________

Signature: ______________________________________ _____ __ Date: _____/_____/_____ (mm/dd/yy)

PLEASE COMPLETE THE APPLICATION AND RELEASE FORMS AND MAIL, E-MAIL OR BRING TO OUR OFFICE IN PERSON. A $300.00 DEPOSIT PER SESSION PAYABLE BY CASH, CHEQUE OR CREDIT CARD WILL BE REQUIRED.

PAUSE AWHILE, 13243 MCCOWAN ROAD , STOUFFVILLE, ON L4A 7X5

Balance of camp fee must be received by Pause Awhile no later than 3 weeks before the start of the session. No refunds if cancelled less than three weeks from the start of your session – otherwise, a $50.00 cancellation fee will apply.