Southern Winds Equestrian Camp 2011 Registration Form

Camper's Name:

 Camper's Age:

Address:

DOB:

City:

  

State:

Zip:

Home #:

  

Cell #:

  

Work #:

 Work # Extension:

Email:

  
     

Camper's Riding Level:  

Beginner (little or no riding experience or lacks confidence)
Novice (can ride gentle horse at a walk and slow trot)
Intermediate (can walk, trot, canter, needing improvement)
Advanced (previous experience and instruction, good form and control)

   

Camp Dates: June 11th -17th  

Drop off is 3:00pm Saturday June 11th and pick up is 3:00pm Friday June 17th. All owners with private horses must provide their own transportation. Timely pickup and drop off is expected.

Tuition: $600.00 per camper. $100.00 due at registration, balance due no later than May 28th, 2011. No registration is accepted without deposit. Make checks payable to: Birchwood Farm

Birchwood Camp T-Shirt
Each child will receive a Camp T-Shirt. Please provide your child’s size, below:

Child's S M L  
  Adult's S M L  

   

Medical Information:  

Child’s Doctor:

  

Dr. contact #:

 

Choice of Hospital:

  

Please list all
drug allergies:

Daily Medications and dose/s:

Please list all
food allergies:

* A copy of your child's insurance card/s must be emailed with each entry form.

   

Back to Southern Winds Equestrian Camp Page
Back to Broxton Bridge Plantation Home Page

 If you are providing a private horse, you must also fill out the private horse registration form. You will also need to print, sign and send the 'Release and Hold Harmless' waiver, send in a copy of your child's insurance card, and read and understand the Camp Rules & Regulations and Camp Checklist.

For more information or questions call or contact:

Birchwood Farm • 1146 Independent School Rd. • Reevesville, SC 29471
Christina Fiedler 843-701-2408 / birchwoodfarm@aol.com or
Lindsey Loppnow 843-452-0887 / lflyingcolors@yahoo.com

Sponsored By: Birchwood Farm, Medicine Wind Stables & Broxton Bridge Plantation