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 *

Woodpecker Camp ($375): Jul 26th - 30th
Deposit only:($100) Balance due July 26th $(275) Jul 26th - 30th Cash or check only

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/

credit card transactions subject to a 3.5% processing fee.

Total

$ 0.00

Name