DREAMCATCHER RANCH
8434 Grizzly Flat Road
Somerset. CA 95684
(530) 642-0322
equicamp@aol.com
REGISTRATION AND LIABILITY RELEASE FORM
REGISTRATION:
Camper_____________________________AKA______________DOB_________Age at Camp______
Address_____________________________________________Height______Weight_____ City______________________________State____Zip___________
Home # (___)______________Camper email ____________________Camper Cell # (___)____________
Parents' or Legal guardian name___________________________Parent email ______________________
Parents Work # (___)______________ Cell # (___)________________FAX # (___)________________
Family changes or special needs that may affect your child's camp experience___________________________________________________________________________
T-Shirt Size: (Circle One) Youth OR Adult (Circle one) Sm Med Lg X-Lg
RIDING EXPERIENCE: Check what describes you best:
Learning to canter____. Independently riding at all 3 gates ____.
Never jumped___. Learning jumping position___. Started over X- rails ____.
Jumping X-rail courses___. Jumping 2' courses___.Jumping 2'6” courses___.
Describe cross-country jumping experience _________________________.
Currently taking lessons____. Leasing a horse____. Own a horse_____.
Trail rider only ____. Western rider_____. Dressage____. Showing_____.
Describe previous “camp” experience (if any) ______________________________________________.
How did you find out us? ______________________________________________________
Preferred Camp Session Number Choices: #____ or #____ Tor register, complete this form and send in with DEPOSIT.
Make check payable to: Dreamcatcher Ranch Balance Due May 1, 2008
CONSENT AND WAIVER OF LIABILITY:
I hereby request that the camper named above attend Dreamcatcher Youth Camp, directed by Carol Saulsberry and Joan Fuquay. In signing this registration, I certify that my child is amenable to discipline and free from habits that would make them an undesirable representative for Dreamcatcher Ranch. I have given Dreamcatcher Ranch full disclosure of any pre-existing physical or mental defects, challenges or problems that my child may have. I agree to abide by the terms of payment outlined in this application. I agree in the event of dismissal or withdrawal on account of homesickness, misconduct, or change of plans, that I will pay the fee in full. I understand that photographs of my child from the camp season are available for publication and that my positive statements about Dreamcatcher Youth Camp maybe used as testimonials. I further acknowledge that I am aware of the unavoidable risks inherent in the types of activities that my child will be participating while attending camp, to include swimming, hiking, group games, and horseback riding/jumping, and being transported by vehicle. In consideration, therefore, for the privilege of riding and or participation in activities around horses at Dreamcatcher Ranch, located at 8434 Grizzly Flat Road, Somerset, CA, the undersigned does hereby agree to hold harmless and indemnify owners or employees of Dreamcatcher Ranch. I further release them from any liability or responsibility for accident, damage, injury or illness to named camper.
Signature of Parent or Guardian_______________________Date: ________
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