Parent Full Name:
Address:
City: ST: Zip:
Email Address:
Phone Day:   Phone Eve:

Camper's Name: 
Age: 
Level of Riding Experience: (check all that apply)

Beginner (no experience)
Novice (some experience, no lessons)
Intermediate (has taken lessons, under 1 year)
Advanced (has taken lessons, over 1 year)
Rides English
Rides Western

 Please Describe: 

Camp Requested To Attend:

  Day Camp (Weeks 4-8 only)
  Stay Camp
  Youth Cowboy Camp (Weeks 1& 2 only)

Please select date
 Dates Requested:  Week 1:  June 18-22 Week 2:   June 25 - 29 Week 3:   July 2 - 6 Week 4:   July 9 - 13 Week 5:   July 16 - 20 Week 6:   July 23 - 27 Week 7:   July 30 - August 3 Week 8:   August 6 - 12

                                Early Arrival?
                                Late Departure?
                                Week End Stay?

 Attending Multiple Weeks? List Dates:

Will You Be Bringing A Friend? Yes    No 

  Please reserve my dates.