Circle-B-Stables
                       Horse Camp Registration

Circle B Stables
5815 Root Road/Spencer, OH./44275
330/667-3293

Name of Child:__________________________________________________________

Complete Address:_______________________________________________________

Telephone:__________________________________________ Date of Birth:________

Parent or Guardian:________________________________Daytime phone:___________

E-Mail Address________________________________________

Medication, allergies, physical and/or mental disabilities:__________________________

If parents are unable to be contacted, please list
two or three other persons that we can contact in case
of emergency:
Name:________________________________________Phone:_____________________

Name:________________________________________Phone:_____________________

Name:________________________________________Phone:_____________________
I UNDERSTAND THAT FOR THE SAFETY OF MY CHILD AND OTHERS, THE FOLLOWING RULES WILL
BE ADHERED TO.  DISRUPTIVE CHILDREN WILL BE DISMISSED FROM CAMP WITH NO REFUND.
1.  RESPECT ADULT AUTHORITIES.
2.  KEEP HANDS, FEET AND OTHER OBJECTS TO YOURSELF.
3.  SAFETY GEAR WILL BE WORN WHEN REQUIRED.
4.  REGARD FOR OTHERS IN MANNER AND SPEECH WILL BE POLITE AND COURTEOUS.

I understand that the fee is $275, a deposit of $125 payable with registration and the remainder $150
upon arrival at camp.

*I give permission to Circle B Stables to care for my child for the week of _________
_________ and understand that my child will be participating in swimming and hiking, and activities
involving horses which will include but may not be limited to: basic horsemanship, leather care; grooming,
tacking up and trail riding.
I have read and understand the Ohio Equine Statute 2305.321, and I have read, signed
and fully understand the Circle B Stables release and waiver.

SIGNED:____________________________________________DATE:_____________