REGISTRATION FORM Summer Camp

NAME (last) ____________________(first)______________________BIRTHDAY_________

ADDRESS_____________________________CITY___________________ZIP___________

PARENT OR LEGAL GUARDIAN________________________________________________

HOME PHONE #_____________________WORK PHONE #_________________________

EMAIL______________________________________________________________________

EMERGENCY CONTACT__________________________PHONE #____________________

NAME OF PERSON(S) ALLOWED TO PICK-UP CHILD:

____________________________________DRIVERS LICENSE #_____________________

CAMP SESSIONS DESIRED
Fee is $275 per session.
Payment must be received in full
to ensure reservation.

Week 1
Week 2
Week 3
Week 4

Week 5     Week 9
Week 6     Week 10
Week 7     Week 11
Week 8

Amount Enclosed:____________

Check Money Order Credit Card

Signature: _____________________________________Date:______________

If paying by Credit Card select one: Visa MasterCard Discovery American Express

Name:____________________________ Card # ___________________________Exp:_________

Amount to be Charged: $_________ Signature:_________________________________________

Mail form and tuition payment (check or money order made out to Capricorn Equestrian)
to: Capricorn Equestrian, 6101 Ben Road, Sachse, Tx 75048.

© 2010 Capricorn Equestrian Center
6101 Ben Road
Sachse, TX 75048
(972) 530-1124
Chad Easterling, Owner
(972) 839-2721
Email