Camper Name: Male Female Age:
Birth Date: Month Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Address Address 2:
City: Prov: Postal Code:
Phone Number: Camper email: Grade: 0 1 2 3 4 5 6 7 8 9 10 11 12 13
Health Card #: - (include letters) Height: Weight:
Allergies:
Tylenol or Gravol to be given?: Please select Yes or No No Yes

Parent/Guardian Information
Name: Relationship to Camper:
Phone Number Daytime: Evening Cell:

Alternate Contact Information
Name: Relationship to Camper:
Phone Number Daytime: Evening Cell:

Does the camper have any physical, emotional, behavioural, dietary, allergies and/or conditions of which we should be aware?
Yes No If yes please state very clearly:   (If you require additional space please attach a separate sheet w/completed form.)
How did you hear about Circle H Ranch? Please Select One Advertisement Flyer A Friend Internet Other
Circle H Ranch does not guarantee a peanut-free environment. We do seek to reduce the risk of exposure and therefore do not use or serve peanuts, peanut products or tree nuts on camp property and nuts, or products containing nuts, will not be available in out tuck shop. However, the food we purchase and serve may contain traces of nut products.

2010CAMP SESSIONS AND DATES.
Camp prices include G.S.T., meals, t-shirt, $10.00 tuck bucks and helmet rental.

Waivers and Conditions of Enrolment: 1. The Camp Director reserves the right to dismiss a camper who, in the Director’s opinion, is a hazard to the safety of others, or who appears to have rejected the reasonable controls of camp. The parent/guardian certifies that the applicant camper is normal in condition and habits and is amenable to necessary discipline. Failure to disclose problem at the time of application could result in dismissal. No refunds are given on dismissals of any type.
2. The parents/guardians submitting the application are those having legal custody over the child. Conditions of custody will be fully communicated in writing to Circle H Ranch Camp. Please note: Registrations are processed once payment is received. An incomplete application and or payment will result in the application being put on hold.
3. I, the parent/guardian of the above named participant, release Circle H Ranch Camp, it’s volunteers, directors, staff and agents from any loss, personal injury, accident, misfortune or damage to the above-named or his/her property, with the understanding reasonable precautions shall be taken to ensure the health and safety of the above named camper.
4. The signature of the parent/guardian on the application shall give the Camp Director the right to arrange for any special services or other requirements necessary for the best interest of the camper and shall give the Camp Director the right to approve and obtain medical attention necessary for the camper’s welfare and good health including ordering injections, anesthesia or surgery. In such situation, the camp will attempt to notify to parent/guardian as soon as possible. The parent/guardian is responsible for any additional expenses that may result from such services.
5. By signing the application you are stating that you fully understand the risks involved with the horseback riding portion of camp. Realizing that horses are living breathing animals with instincts of their own, and are capable of biting kicking, stepping on or running into the camper at any given time. Precautions will be made to make the camper’s experience a safe one. A separate horse riding waiver must accompany this application before the camper is allowed to ride.
6. I agree to permit reasonable use of photos and videos of the applicant camper in promoting the camp or camp activities or programs.
7. I have read and agree to the waivers and conditions of this application, by signing I accept all conditions of enrollment.

Parent/Guardian Signature: ____________________________________________ Dated: ______________________________________

Rider Name: Male Female Age:


Parent/Guardian Name:
I understand that the sport of horses is a high-risk sport and that I am participating at my own risk and in full knowledge that there is some element of risk, that an accident could occur and may result in injury or death to the rider or their mount. In consideration of acceptance of this entry or my being permitted to take part in this event, I agree to save harmless and keep indemnified, Circle H Ranch, Directors, Counselors, and anyone assisting in the program, and the property from and against all claims, actions, costs and expense and demands in respect of death, injury, loss or damage to my person or property, however caused, arising out of or in connection with my taking part in this program. It is understood and agreed that this agreement is to be binding upon myself, my heirs and assigns.

Parent/Guardian Signature: _____________________________________ Date:_____________________

Witness: ___________________________________________________ Date: ____________________