| 2008 Summer Horse Camp Registration Form Head for the Hideaway 1022 Private Road 1250, Bluffdale, Texas 76433 Traci Niedziela Phone: (254)823-6606 |
| Necessary Forms |
- Camp Session #1 - June 16-19_____
- Camp Session #2- July 21-24_____
- Camp Session #3- August 4-8_____
- Please Check the camp session of
your preference
Riding Level
___ Beginner ( little or no experience)
____ Novice ( can ride a gentle horse
at a walk and trot)
___ Intermediate ( can walk, trot &
canter, but needs to improve)
___ Advanced ( previous instruction,
can walk, trot & canter well)
___ Beginner ( little or no experience)
____ Novice ( can ride a gentle horse
at a walk and trot)
___ Intermediate ( can walk, trot &
canter, but needs to improve)
___ Advanced ( previous instruction,
can walk, trot & canter well)
Name:
Address:
City/State/Zip:
Work Phone: Cell:
Home Phone:
Email:
Best Way to Contact:
Sex: M / F Birthdate: Age:
Height: Weight:
State Law Requires We Have The Following On File:
Immunizations: DPT____ MMR____ TB____ Polio____
Allergies: Insect Stings_____ Asthma_____ Food_____ Other_____
Please use the following space to supply The Hideaway Ranch with any
information (physical, medical social, physchological)
Camp T-Shirt Requested:
$15 includes tax. Circle One : Childs S M L Adult: S M L XL
Insurance Information:
Release of Liability:
The following participant acknowledges the inherent risks which are involved in riding and
working around horses. The risks may include, but are not limited to, damage to personal
property, illness, bodily injury, trauma or death resulting from a fall while riding or being in
the close proximity to horses.
The participant further understands that both horse and rider can be injured in the
normal course of events while hacking, schooling, or competing, and therefore agrees to
indemify and hold harmless Rolling Stone Ranch and The Hideaway Ranch and Retreat. It
further releases any employees, or anyone associated with these businesses from any liability
or responsibility for any accident, injury, damage or death to the participant or any property
that is owned by the participant.
Signature of Participant ( Parent or legal guardian if under 18)
Name of Participant
Address:
City/State/Zip:
Work Phone: Cell:
Home Phone:
Email:
Best Way to Contact:
Sex: M / F Birthdate: Age:
Height: Weight:
State Law Requires We Have The Following On File:
Immunizations: DPT____ MMR____ TB____ Polio____
Allergies: Insect Stings_____ Asthma_____ Food_____ Other_____
Please use the following space to supply The Hideaway Ranch with any
information (physical, medical social, physchological)
Camp T-Shirt Requested:
$15 includes tax. Circle One : Childs S M L Adult: S M L XL
Insurance Information:
Release of Liability:
The following participant acknowledges the inherent risks which are involved in riding and
working around horses. The risks may include, but are not limited to, damage to personal
property, illness, bodily injury, trauma or death resulting from a fall while riding or being in
the close proximity to horses.
The participant further understands that both horse and rider can be injured in the
normal course of events while hacking, schooling, or competing, and therefore agrees to
indemify and hold harmless Rolling Stone Ranch and The Hideaway Ranch and Retreat. It
further releases any employees, or anyone associated with these businesses from any liability
or responsibility for any accident, injury, damage or death to the participant or any property
that is owned by the participant.
Signature of Participant ( Parent or legal guardian if under 18)
Name of Participant
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| Remember if you have any questions you can contact: Traci (866) 609-HIDE or Lauren (817) 578-6225 |