Summer Day Camp RegistrationAges 4 and Up

I am going to horse around at TJ Stables from 9am to 4pm the Week of: ___________

$299Child's Name: ___________________________ Date of Birth: _________ Age: ______ Address: _______________________________________________________________City: ____________ ________________________ Postal Code: __________________Home Phone: _____________________ Emerg. Phone: ________________________Work Phone: ______________________ Cell Phone: ___________________________E-mail Address: _________________________________________________________ Health Card #: ______________________ Family Doctor: _______________________Health Problems or Special Needs?: _________________________________________Allergies: Please provide details (dust, food, insect bites, repellent, etc.) and treatment required: __________________________________________________________________________________ Does your child have medical or behavioural issues? Give details: _______________________________________________________________________________________________________________________________________________________________Does your child require any assistance or medication at school?: _________________________________________________________________________________________

Camp Registration for the Week of: ________________ Order Video? Y/N (Additional $25)

____________________ ____________________________________________Date Signature of Parent or Guardian

$100 Depositwith application.Balance due firstday of program.

I desire my child to participate in TJ Stables Summer Day Camp and all activities unless I advise otherwise in writing. I agree that if my childfails to complete the program, fees will not be refunded. I, the undersigned hereby consent to my child's use of the facilities of TJ Stablesat RR7 Chatham, Ontario, knowing that there is no warranty as to the fitness or condition of horses and equipment on the premises andon behalf of my child, I hereby release Terry Jenkins, TJ Stables and their employees, as well as the property owners, from any liability,past, present or future in connection with my child's use of the facilities. I understand and agree that TJ Stables shall not be liable for anyinjuries or property damage, howsoever caused. Should TJ Stables determine that my child cannot keep up to the class, or is at risk or putsothers at risk, a worker will be provided by TJ Stables and I agree to pay any additional fees for this service. TJ Stables reserves the rightto withdraw a participant for safety or behaviour reasons with NO refund. I am enclosing the required deposit of $100.00, the balance duefirst day of the program. In the event my child cannot attend the program and an alternate date cannot be arranged, I am aware my depositof $100.00 will not be refunded. I also give my permission to send my child information & print material informing of future activities or eventsat TJ Stables. I also give my permission to use any photographs or videos taken for promotional use.

CONSENT AND WAIVER OF LIABILITY: (Please read Carefully)

Office Use Only

I NEED TO BRING: Lunch and snacks, lots to drink. Ice cream andsoft drink products are available for purchase from $1.00 to $2.50. RIDING FOOTWEAR AND CLOTHING: Sunblock, bug spray, boot orshoe with heal (minimum 1/2'' at arch), rain boots are permitted. ABSOLUTELY NO sandals or crocs allowed. Sweat pants are best topull over shorts for riding. TJ Stables will supply proper riding hel-met and for camp activities you may wear shorts & running shoes.Come dressed for the weather, a change of clothes, rain gear anda jacket or sweater and don’t forget to wear your smile!

Balance due Monday________________

519-354-7517tjstables@ciaccess.com837 Gregory Dr. East

RR#7 Chatham N7M 5J7

Camp Fee: ___________Video: ($25) ___________ TOTAL: ______________Deposit: ______________Balance: _____________ STABLES

HORSEBACK RIDING

STABLES HORSEBACK RIDING

+taxMonday to Friday 9:00 am to 4:00 pm2014 Dates: July 7, 14, 21, 28, August 4, 11, 18Horse Mania - June 30 $450 Advanced Camp - August 25 $385