Glendale Farms Summer Day Camp And March Break Camp Form

March Break / Summer Day Camp

Name First Last
Age
Date of Birth / MM / DD YYYY
Gender Male Female
Address
City
Province
Postal Code
Email
Mother's Name First Last
Home Phone - (###) - ### ####
Work Phone - (###) - ### ####
Father's Name First Last
Home Phone - (###) - ### ####
Work Phone - (###) - ### ####
Emergency Contact
Home Phone - (###) - ### ####
Returning Camper Yes No
Other Contact
Relationship
Phone - (###) - ### ####
Doctor's Name
Phone - (###) - ### ####
Health Card #
Allergies
Week Requested (For march break, please choose march break for both weeks)
Second Choice (For march break, please choose march break for both weeks)
Horse Knowledge
Horse or Pony request