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Camper's Name (required)

Date of Birth (required)

Gender (required)

Full Address (required)

Phone Number (required)

Email (required)

Doctor (Name)

Doctor (Phone Number)

Person To Contact In Case Of Emergency (Name)

Person To Contact In Case Of Emergency (Phone Number)

Hospital Health Number

Previous Injuries

Allergies, Medications and/or other info and conditions

Previous riding experience

I would like to rent a riding helmet for $25/week

Please write down desired camp week session(s) (See Fees and Schedules for more details.)

I agree that my child may participate in any and all of the camp's activities, unless otherwise agreed upon below. I agree that all precautions will be taken at your discretion, and that you shall not be responsible for any accidents or sickness to my child. Should emergency treatment be required, I hereby consent for him/her to receive medical attention needed. All attempts will be made to contact parent/guardian prior to any treatment.

I have read and agree to these terms stated above (required) Yes

Name of Parent/Guardian agreeing to the Acknowledgement of Risk (required)

Date (required)

Please send deposit of $150.00 to Grandview Farms, 570 Hwy. #20, Fenwick, Ont. L0S 1C0

Balance is due upon arrival, Monday morning. Payment can also be made via e-transfer to “”