Kids ‘N’ Bits Western 

Web Form

2007 western camp registration form.

Childs name:                                                                            

Address:                                                                                  

Phone:                                                                                     

Birth Date:                                                    Age:                     

Parent/Guardian Information:

Name:                                                                                      

EMERGENCY #:                                                                    

Family Doctor:                                                                         

Emergency Daytime #:  ________________________________

Health Card  #:   ______________________________________

Does your child have any allergies or other conditions we should know about?

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please circle the week you are planning to attend:

March Break                         Summer Camp( DATES TO BE SET)

Total Cost:   $350.00 per child/ $600.00 for two children/

Half days available: $200.00

Please make cheques payable to: ANNE PHILIPS

   Kids ‘N’ Bits Western 

Web Form

2007 western camp release form.

I understand that the ‘Sport of horses’ is a high risk sport, and my child is participating at my own risk.

I understand that while participating in the kids ‘N’ Bits western program, my child must wear a fixed helmet with harness and shoes or boots with heels for safety.

I also agree  that Kids ‘N’ Bits and/or Phillips Farms are not liable for damages or injuries incurred while participating in this high risk sport.

Childs name:                                                                            

Date of birth (DD/MM/YEAR): ____________________

Age: __________

Home Phone #:   _____________________________

Other Contact # :_____________________________

I acknowledge as parents/guardian of ___________________________________

                                                                       (Childs Name)

that I have read, understand, and agree to the terms and conditions stated herein.

Adults name (please print): ______________________________________

Please sign: ___________________________________________________

Date: ________________________________________________________

Copy also available at Luton Park.