Summer Camp Application - Woodpecker Farm

Parent's Name *

First

Last

Child's Name *

Please complete this form for each camper.

Child's Age *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

Riding Experience *

For example, please specify the years of lessons.

For Advanced Campers: What skills would you like to focus on?

Medical Conditions

Select Camp Dates *

If you would like to register for more than one week, please complete this online form again.

Credit Card *

Card Number

Security Code

Name on Card

Expiration/

Payment-in-full credit card transactions subject to a 3.5% processing fee.

Total

$ 0.00

Name