Circle-B-Stables                       Summer 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 one week camp fee is $200, payable with a $100 deposit and the remaining $100. to be paid on the first day of camp (Camp hours being 10 a.m. until 3 p.m.).         Add $50.00 if your child will be participating in the overnight 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 further understand and give my permission for my child to participate in field trips requiring him/her to travel to Spencer Lake Wildlife Preserve and Letha House Park.       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:_____________
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