Schauber Stables

428 Schauber Road Ballston Lake NY

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July 2010

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Summer Camp 2010 Application

Please fill in all applicable fields below. Your Riding Camp Application cannot be processed without this information!

Don't want to fill the form in online? You can download, print, and complete it by clicking below:

>> Download Riding Camp Application. <<

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Begin Form

Fields marked with * are required.

Send a copy to yourself

About You

Your Name *

Your Email *

Your Phone *

About the Camp Rider

Rider's Name *

Gender *

Male

Female

Date of Birth *

Age *

Rider's Address

Street *

Town *

Zip *

Rider's Mother

Mother's Name

Mother's Home Tel.

Mother's Cell No.

Mother's Work Tel.

Rider's Father

Father's Name

Father's Home Tel.

Father's Cell No.

Father's Work Tel.

Emergency Contact

Emergency Name *

Emergency Address *

Emergency Phone No. *

Picking up the child

List any individuals who may pick the child up from camp

Riding Experience

Has your child ever taken riding lessons *

Yes

No

If yes, when

Western or English

Approximate number of lessons

How would you describe your child's riding ability

Can your child groom a horse independently

Yes

No

Can your child pick a horse's feet independently

Yes

No

Can your child tack a horse independently

Yes

No

Can your child ride a horse at the walk independently

Yes

No

Can your child ride a horse at the trot independently

Yes

No

Can your child ride a horse at the canter independently

Yes

No

Can your child ride a horse going over ground poles independently

Yes

No

Can your child ride a horse going over cross rails independently

Yes

No

Can your child jump a horse independently

Yes

No

Has your child ever had a bad experience with a horse

Yes

No

If yes, please describe

Is there anything else that we should know about your child in order to make his or her week at camp more enjoyable

Choose Session(s)

Session 01: 06/28 - 07/02

Session 02: 07/05 - 07/09

Session 03: 07/12 - 07/16

Session 04: 07/19 - 07/23

Session 05: 07/26 - 07/30

Session 06: 08/02 - 08/06

Session 07: 08/09 - 08/13

Session 08: 08/16 - 08/20

Session 09: 08/23 - 08/27

Session 10: 08/30 - 09/03

Is before care or after care needed

Yes

No

If yes, please specify the dates and times you need before care and/or after care along with any other particular needs

Emergency Medical Release

I am aware that my child is participating in summer riding camp at Schauber Stables

to Schauber Stables, LLC and its staff and volunteers to act on my behalf in the event of a medical emergency.

Physician

Physician's Tel.

Dentist

Dentist's Tel.

Insurance Company

Policy No.

Name of the insured

If a parent or guardian cannot be reached, please contact in this order

Contact 01

Tel.

Contact 02

Tel.

Contact 03

Tel.

Please indicate any additional health or medical concerns that Schauber Stables, LLC should be made aware of

Does the child have any of the following

Asthma

Seizures

Severe Allergy

Other Allergies

Special diet

Diabetes

Last Tetanus (date)

History of Surgery (describe)

Physical limitation

Other

Does the child require any medications. If so, please identify

Can the child administer the medication him or herself

Yes

No

Submitting

Please note that by clicking the "Send" button you warrant that the above information is correct and true to the best of your knowledge

Spring Camp Session 04/05 - 04/09

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