HORSEMANIA       CAMP

www.horsemaniacamp.com                                 901-634-7484

REGISTRATION FORM

Camp Date   _________________

Camper's Name   ______________________________________________         Age_______

Address   ___________________________________________________

                              ___________________________________________________

Home Phone Number     ______________________________

Parent's Work Number ______________________________

Parent's Cell Number       ______________________________

Email Address                           ______________________________

Parent or Guardian's Name                       ______________________________

Emergency Contact Person                       ______________________________

Phone Numbers                                                                               ______________________________

My child may be picked up by                       ______________________________

Signature     _________________________________

Date                       _________________________________

How you heard about Horsemania Camp               Newspaper Ad   ___           Flyer____       Referral____     Internet____   Other_____