East Ridge Stable
2011 Summer Camp Registration
Camper's Name: _____________________________ Age: ______ Date Of Birth: _________
Address: City State Zip
Parent(s) or Guardian: ____________________________________________________________
Address: ________________________City _________________State _________ Zip_________
Home Phone: _________________ Work Phone: _____________Cell Phone: ________________
E-mail address:
Emergency Contact Info:
Name: __________________________________________ Relationship to Camper_________
Phone Number: or
Summary of special conditions or needs, Allergies, Asthma, Medicines, Food Allergies, etc.
Please provide detailed special needs info prior to the start of camp.
2011 Rates:
1-10 Day Sessions $ 60.00 per, 11- 20 Day Sessions $ 55.00 per, 21 or more Day Sessions $50.00 per
Please select your dates below, and indicate your choice of days.
