Summer Camp Registration Form
Mountain View Adventures
17366 Telkwa High RD
Smithers, B.C. V0J 2N7
http://www.mvtrailriding.com
Participant Information
*
First Name
*
Last Name
*
Sex
M
F
*
Age
8
9
10
11
12
13
14
15
16
17
Birth Date
*
Medical Insurance #
*
Weight
*
Height
*
Riding Experience (if any):
Special Food Requirements (if any):
Allergies/Medical Conditions (if any):
Special Requests (if any):
Parent/Guardian Information
*
First Name
*
Last Name
*
Relationship:
Mother/Father
Grandparent
Guardian
Other
*
Address:
*
City
*
Province:
BC
AB
SK
MB
ON
QC
NL
PEI
NB
NS
YT
NT
NU
*
Postal Code:
*
Email Address:
*
Phone Home:
*
Work Phone:
*
Cell Phone:
Emergancy Contact Other Then Parent/Guardian
*
First Name
*
Last Name
*
Phone Number:
*
First Name
*
Last Name
*
Phone Number:
Arrival and Departure Information
*
Date of Arrival:
*
Date of Departure:
Weekend Stay Required?
Yes
No
How Many?
1x$50
2x$100
3x$150
4x$200
5x$250
6x$300
Does your child require pickup at bus, train or airplane?
No
Yes
Extras and Add Ons
Will your child require a helmet rental? ($10 fee)
Yes
No
Would your child like a picture CD of thier week? ($15 per CD)
Yes
No
Would your child like a special 2012 camp t-shirt? ($15 per shirt)
Yes
No
Please select a size
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Conditions & Agreements: (please read and sign below)
*
A non-refundable
$75
deposit/per week is required with the booking.
Balance of camp fees are due no later than
June 1
st
2012
. A $ 50 late charge will apply for all payments received after the due date.
For bookings made after June 1
st
the full amount is required
at the time of booking.
Please make cheque or money order
payable to Mountain View Adventures
.
No reductions in costs for any reason are allowed for campers arriving late or leaving early. No refunds will
be made for students sent home early for misconduct. Refund polices can be found on our website at
www.mvtrailriding.com
Insurance coverage of the student is the responsibility of the parent or legal guardian
I wish my child to participate in the full program and all activities, unless I advise otherwise in writing.
If while at camp, my child should become ill or injured, the directors have my full permission to take whatever action they deem necessary or advisable and authorize appropriate medical treatment. I understand that as a parent or guardian, every effort will be made to contact me as soon as possible. I agree to be responsible for any expenses incurred.
I have been advised that wearing proper footwear and a riding helmet can prevent, or significantly
reduce injuries to my child in the case of an accident and I understand that I have to provide such equipment, should I wish my child to wear it.
The wearing of an
approved riding helmet
is mandatory and helmets can be rented if so required.
I hereby acknowledge that I am fully aware that there are risks in horse/outdoor activities, even when all due care is taken by supervising staff. Therefore I agree to assume all risks involved in sending my daughter/son to camp, including traveling before and after. I agree to pay the cost of any emergency evacuation that might become necessary. I agree to Angelika & Peter Langen, Tanja & Shawn Landry Christian Enterlein, Mountain View Adventures, their servants and agents relieving themselves of all liability for losses and damages of all and any description. I acknowledge having read this liability release and confirm my acceptance of the release. I am over 19 years old.
Signature of Parent/Guardian:
*
Date Signed:
*
Indicates Response Required
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