Please provide the following contact information:

Camper Info:

Camper's Name
Camper's Age
Address
City
Zip Code

 

Parent's Name
Work Phone
Home Phone
Cell Phone
E-mail

 

How long has this child been riding?

          Never ridden         
          1 year or less
          1-5 years
          5-10 years
          10 or more years

What type of riding has the child done?

          Hunt Seat
          Dressage
          Eventing
          Western

Does the child have any jumping experience?

          Yes
          No

How much horse show experience has the child had?

          No prior showing experience
          Some prior showing experience
          Extensive showing experience

What level of showing has the child competed at?

          A-circuit
          B-circuit
          C-circuit
          N/A

In which divisions?

          Hunter
          Jumper
          Equitation
          None of the above

Session Dates:
Please click on the date(s) of your choice:

Session #1	June 9 to June 13
Session #2	June 16 to June 20
Session #3	June 23 to June 27
Session #4	June 30 to July 4
Session #5	July 7 to July 11
Session #6	July 14 to July 18
Session #7	July 21 to July 25
Session #8	July 28 to Aug 1

Early Bird Drop-off:  8am to 3pm $50 extra per session

Family Household Discount: 2 or more siblings from the same family, save $25 per session

Name of siblings:

Name	Age
Name	Age
Name	Age
Name	Age

 

Does the child have any physical, mental or emotional problems that we should be aware of?  If so, please explain below:

 

Does the child have any allergies?  If so, please list/describe:

          

Is the child on any medication(s) that must be administered during the hours of camp?  If so, please explain below:

 

Please type any riding accomplishments or additional information
   in the box below:

 

How did you hear about The Detroit Equestrian Club Summer Day Camp?
T.V. news
Newspaper
Magazine
A friend
Drove by the fairgrounds and saw the sign
Other   How?

          WAIVER OF LIABILITY & RELEASE AGREEMENT - PLEASE READ CAREFULLY

          WAIVER OF LIABILITY AND RELEASE WARNING! Under the Michigan Equine Activity Liability Act, an Equine Professional is not liable for any injury to or the death of a participant in any equine activity resulting from an inherent risk of the equine activity. The rider whose name appears on this form, and/or the parent or guardian of a rider who is under 18 years of age ("Junior Rider"), acknowledges that they are voluntarily participating in horse activities. They are fully aware that horses and horse sports and competitions are dangerous and involve inherent risk of injury, death or loss. As a condition of being permitted to ride, take riding and jumping training at Detroit Equestrian Club, L.L.C., Christopher Ewing, and its directors, shareholders, affiliated companies, employees, independent contractors and agents, competition at shows and clinics with a designated trainer, whether or not Detroit Equestrian Club's facility, and boarding horses at Detroit Equestrian Club (if applicable), the rider, and/or the parent and/or guardian of a "Junior Rider", agree to indemnify and hold Detroit Equestrian Club L.L.C., Christopher Ewing, any designated trainer or any Detroit Equestrian Club L.L.C. agent, harmless and not sue or make any claim against the above mentioned, at all for any injury, death, or loss or for any reason whatsoever, whether such injury, death or loss results directly or indirectly from negligent acts or omissions of Detroit Equestrian Club L.L.C., Christopher Ewing, any designated trainer or any Detroit Equestrian Club L.L.C. agent. They also agree to comply with all riding and showing rules and policies established by Detroit Equestrian Club L.L.C., Christopher Ewing, any designated trainer or any Detroit Equestrian Club L.L.C. agent.

I, , the parent and/or guardian, of the camper described above, have read the above information, including the Waiver of Liability & Release Agreement, and declare my agreement with all of the terms above by placing my initials in the following box below as an electronic signature,
and then clicking on the "Submit Camp Registration Form".  I also understand that I will need to sign a hard copy form of this agreement prior to the beginning of camp.