Registration for Camps

Gender *

male female

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Secondary parent/guardian *

First

Last

Secondary Parent Address *

Line 1

Line 2

City

State

Zip Code

Country

Secondary Parent Email *

Participant's Name *

First

Last

Gender *

Male Female

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Do you speak english? *

Yes No Some

Primary language spoken *

Previous Equine Experience *

Previous Riding experience *

Do you have valid visitor's health insurance for Canada for the duration of your stay? *

yes No

Has the participant had any previous serious injuries by any cause? *

Does the Participant have pre-existing medical conditions *

yes no minor

Medical Notes: details of previous serious injuries or Medical Health conditions *

Please register the participant for the following Camps *

ESC Spring Break Groom School April 20 - May 04 Summer Camp for dates below

Please register the participant for *

Groom School Summer Program Rider Levels Summer Program

Option for Tuition only or tuition and hotel *

Tuition Only Tuition and Hotel

I wish to register the Participant for ESC Summer Camps for the following weeks in the *

Week 1 June 29, 2014 - July 06, 2014 Week 2 July 06 - July 13,2014 Week 3 July 13 - July 20,2014 Week 4 July 20- July 27, 2014 Week 5 July 27, 2014 - August 03, 2014 Week 6 August 03, 2014 - August 10, 2014 Week 7 August 10, 2014 - August 17, 2014 Week 8 August 17, 2014 - August 24, 2014

Participants coming for Rider Levels *

I am bringing my horse I am not bringing a horse

Preferred method of payment *

Visa Mastercard American Express Direct Debit

Registration for Equine Studies Canada Camps