Summer Camp 2013 Sign up Form

Name:__________________________________________________________________

Address_________________________________________________________________

PhoneNumber_____________________Emergency#_____________________________

RidingExperience_________________________________________________________
 ________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Week(s)Desired:__________________________________________________________

_______________________________________________________________________
Horseback Riding is a dangerous sport. It is possible to be bit, kicked,
 knocked down.  It is possible to fall off and get injured.
In case of an emergency,  please list the name of the contact you would want
 to be notified:
Name__________________________________________________________________
Address_________________________________________________________________
Phone #___________________________________________________________

Please fill your form and return with a $50.00 NON-REFUNDABLE deposit
to:

CRANBERRY ACRES EQUESTRIAN CENTER
  12500 FIVE FORKS ROAD
   AMELIA, VA  23002

IF YOU HAVE ANY QUESTIONS:
 PLEASE CONTACT US AT 561-3072 OR CRANBERRYACRES@LUCKYMAIL.COM