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  Fax/Phone (407) 568-8418 ; www.mikendafarm.com
Summer Camp Registration Form

We are holding Summer Camp during the following week.  Please put the number 1 or 2 for your first and second choices!

"Please check which scheduled days you would to register for..."

__June 13-17 __June 25-29

Summer Camp ~ $240 per week         Camp hours are 8:30 a.m. to 2:00 p.m.

Please send in one-half deposit to Mikenda Farm prior to camp.   All deposits received are non-refundable.  Balance of registration fee due the first day of camp.


PARENT'S NAME _________________________________________________________

ADDRESS _________________________________________________________________

CITY____________________________ ZIP ______________

EMAIL ADDRESS____________________________________________

DAYTIME PHONE # _____________________ EVENING PHONE #_____________________EMERGENCY # _______________________

HOW DID YOU LEARN ABOUT US ______________________________________________________________________________________

CHILDREN INTERESTED IN ATTENDING THE HOLIDAY CAMP:

Name of Child
____________________________

Age
_____

Experience Around Horses
___________________________________________

Name of Child
____________________________

Age
_____

Experience Around Horses
___________________________________________


LISTED BELOW ARE ANY HEALTH PROBLEMS OR CONDITIONS THAT SHOULD BE NOTED:__________________________________________________________________________________________________

The camp hours are 8:30 a.m. to 2:00 p.m. Parents who will have difficulty dropping off or picking up their child at those times can request extended hours for an additional hourly charge.  Please indicate here ________________________________________.

FOR AND IN CONSIDERATION OF THE ABOVE SERVICES, Equine Participant does forever and finally release, remise, acquit, satisfy and forever discharge Brenda Hagemeister DBA Mikenda Farm and those individuals listed as Mikenda Farm Instructors of and from all manner of action and actions, cause and causes of action, suit, debts, dues, sums of money, bonds, billings, contracts, controversies, agreements, promises, damages, variances, judgments, executions, claims and demands whatsoever, in law or in equity, which may arise or might in the future arise or hereinafter may arise for or against Brenda Hagemeister DBA Mikenda Farm and those individuals listed as Mikenda Farm Instructors for the services stated above.

This document is meant to be a full and complete release from any and all liability that may arise from instructing the Participant on how to properly ride, manage and care for horses. This release is given freely and voluntarily by the Participant and is meant to remain in existence throughout the duration of any instruction.

WARNING: Under Florida law, an equine activity sponsor or equine activity professional is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities.

___________________________________________           ____________
PARENT'S SIGNATURE                                                                 DATE
 

Please print this form and fill out completely, then return form with your payment to:
 

MIKENDA FARM
4740 Lazy H Lane
Christmas, FL 32709
Fax/phone (407) 568-8418

 


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Last Updated: 2/26/2010
© 2001-2009 Mikenda Farm