Summer Camp Application

Summer Camp Application

Please download file, print, fill out information, and send by US mail
with $50.00 deposit to the address above.

BLACK’S HORSES & PONIES

 

16045 Rococo Rd. Tallahassee, FL 32309

 

Office/stable (850)893-7212

 

www.blacksponies.com

 

Summer Camp Application

Mail in with $50.00 deposit to the address above.

Please indicate weeks requested: _______________________________

Name:
_____________________________________________________________

 Address:
_____________________________________________________________

 Age:
___________

Height:
__________

Weight:
________

Grade:
__________

 Mother’s Name: ____________________________________________________________

 Address:
____________________________________________________________

 Home Phone:
________________________


Business Phone:
______________________


Email Address:
_______________________

 Father’s Name: ____________________________________________________________

 Address:
____________________________________________________________

Home Phone:
_____________________

Business Phone:
______________________

 In case of emergency contact:
___________________________________________

___________________________________________

Physician’s Name:
_______________________

Phone:
________________________

Known Allergies:
______________________________________________________

 Comments:
__________________________________________________________

___________________________________________________________________

 I, ___________________________________, hereby authorize BLACK’S HORSES & PONIES to secure medical services for my child _____________________________ if necessary.

 Signature:

___________________________________            

Date:
______________________

                                                                      

 From time to time we look for new images of our fun days at camp to display in our barn, on our web site, in our promotional materials, and at locations of partner companies, etc.  If you prefer that we not use any images with your child in them, just check the box next to “No thanks, I prefer to decline.  Please don’t use my images”.  Either way, we hope you have a blast at camp.  I know we will!

 ____
Yes, you may use images of my child.

 ____
No thanks, please do not use images of my child.

 

DOWNLOAD NOW !!

CampApppage12011.pdf
(182k)

 In order to view and print out
the application form, you will need
to download Adobe Acrobat Reader
available by clicking on the link below…

 Download Acrobat Reader Now!

 

Release

 

BLACK’S HORSES & PONIES

16045 Rococo Rd. Tallahassee, FL 32309

Office/stable (850)893-7212

www.blacksponies.com

Summer Camp Application

                             Mail in with $50.00 deposit to the address above.

 

Please indicate weeks requested: _______________________________

 

Release

 

I/We ____________________________________________________________, parent(s) or legal guardian(s) of ______________________________________ (child), by enrolling my/our child in Black’s Horses & Ponies, Inc. Summer Riding Camp, certify that I/we are cognizant of Florida Statutes 773.04 which states as follows:

“UNDER FLORIDA LAW, AN EQUINE ACTIVITY SPONSOR OR EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO, OR THE DEATH OF, A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISK OF EQUINE ACTIVITIES.”

BLACK’S HORSES AND PONIES, INC. AND STAFF REQUIRE OUR SUMMER CAMPERS TO PROVIDE AND WEAR PROTECTIVE HEADGEAR (HARD HAT) AND BOOTS pony graphicOR SHOES WITH A HEEL.

I/We hereby release Black’s Horses & Ponies, Inc. and any staff members affiliated with Black’s Horses & Ponies, Inc. from any responsibility for any occurrence in connection with the Summer Riding Camp which may result in injury, death, or other damages. I/We further state that I/we are of lawful age and competent to sign this affirmation and release and that by signing I/we understand the terms therein.  I/We assume all responsibility for _________________________ (child)’s physical fitness and capabilities to perform under normal conditions of the Black’s Horses & Ponies, Inc. Summer Riding Camp.

 In witness whereof I/we have executed this affirmation and release on this _____________ day of ___________________, 20_____.

Parent or Guardian Signature:
_________________________________  

 

 

DOWNLOAD NOW !!

CampApppage22011.pdf
(184k)

 

In order to view and print out
the release form, you will need
to download Adobe Acrobat Reader
available by clicking on the link below…

 

Download Acrobat Reader Now!