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Nirvana Horse Camp
Email
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Camper's First Name
*
Camper's Last Name
*
Camper's Age
*
6
7
8
9
10
11
12
Camper's Allergies or Medications
*
Camper's Gender
*
Male
Female
Prefer not to say
Daytime Emergency Contact Phone
*
Long answer
How would you describe your child's experience riding horses?
*
No Experience
Beginner
Intermediate
Very Experienced
Select which one you are registering for
*
July 12th to July 15th
August 2nd to August 5th
I consent to having photos of my child posted online
*
Yes
No
My child can have hair extensions put in
*
Yes
No
My child can drive a tractor
*
Yes
No
My child has physical limitations that require special accommodations
*
Yes
No
Maybe
If you answered maybe in the previous question please explain:
Parent/Guardian Name
*
Parent/Guardian Phone
*
Second Parent/Guardian Email Address
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