Registration From

Phelan Training Stable - Registration Form 2008

Child's Last Name: ___________________________________________________________________

Child's First Name: ___________________________________________________________________

Child's Date of Birth : _________________________________________________________________

Parent/Guardian Last Name: ____________________________________________________________

Parent/Guardian First Name: ____________________________________________________________

Address: ___________________________________________________________________________

City/Town: _______________________________________________ Zip Code: __________________

Home Phone: __________________

Work Phone: ___________________

Cell Phone: ____________________

Emergency Contact: _____________________________________________________

Emergency Phone: ______________________________________________________

Does your child have special medical needs? Yes No

If yes, please describe: ________________________________________________________________

Please Circle which camp session you would like:

July 14th - 18th

July 28th - August 1st

August 11th - 15th

A copy of the Release and Hold Harmless Agreement Form has been saved in a PDF file format and requires a copy of Acrobat Reader for viewing and printing. The majority of computers already have a copy of Acrobat Reader installed. If you do not presently have a copy of Acrobat Reader installed you may download a free copy at the Adobe website.

DOWNLOAD REGISTRATION FORM

PHELAN TRAINING STABLE - 2218 VICTOR ROAD - BLOOMFIELD, NY 14469 - 585-657-6952

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