Glendale Farms Summer Day Camp

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
Second Choice
Horse Knowledge
Horse or Pony request