Holiquin Application


Holiquin Registration

*Note* Please print out this application - fill in the required
information and mail it to Holiquin. Thanks.

 

Summer Camp - 2008


Summer Riding Sessions

5 week lesson series


July 7 thru August 8 ( no lessons July 21 to 25 ) $25.00 depost required with application. Balance of lesson fee due by June 1st.
  • One lesson per week - $175.00
  • Two lessons per week - $350.00
  • Three lessons per week - $525.00
  • Four lessons per week - $700.00
  • Five lessons per week - $875.00

Camp Fees & Registration

$50.00 deposit per week, non-refundable, to be sent with application. Balance to be paid on or before May 1. In order to maintain our small enrollment, absolutely no fees will be refunded or credited after May 1.

Name:_________________________________________________
Birth Date:___________________________Age:______________
Height:_______________________________Weight:___________                                                                        
Address:________________________________________________
Email Address:____________________________________________

Do you require a special diet?_________________________________

How did you learn of Holiquin Camp?_____________________
____________________________________________________
Dates you wish to attend camp:__________________________
Riding Experience:_______________________________________
Do you have a hard hat with chin strap?__________________
Do you wish to rent a hard hat at $5.00 per week?________
Do you wish to bring your own horse to camp?______________
Number of weeks you wish to attend camp:________________
Parents Name:___________________________________________
Phone:__________________________________________________

Medical Information

**This form must be filled out for registration to be complete.

  • Has child had usual childhood diseases?_______________ If "no",


  • which ones has the child NOT had?_________________________________

  • If YES, please list.______________________________________________

  • Any serious illnesses or operations?______________________________

  • Date of last TETANUS booster:_____________________________________

  • Any allergic reactions to: Bee sting____Penicillin____Hay Fever

  • Poison Ivy/Oak/Sumac___________ Other:_________________________

    • (Written directions should accompany any medications sent to camp for Nurse to dispense.)
    Does the child have any of the following problems?
  • Bedwetting______________Heart Problems________________

  • Kidney Problems_________Convulsions___________________

  • Ear Infections____________Fainting______________________

  • Diabetes________________Sleep Walking_________________

  • Other:________________________________________________

    • ** I give my consent for emergency medical treatment from a physician or local hospital in the event that my child is injured or becomes ill during his/her stay at camp. I also give my permission for this child to be transported to and from field trips and other camp related activities.
    Signature:(Parent/Legal Guardian)____________________________________________

    A Horse Riders Release must be signed by both parents before the child may attend camp.

    Mail to:

    Holiquin Riding Center
    15052 Wingerton Road
    Waynesboro, PA 17268

    Upon receipt of these forms and your registration fee, you will receive an acknowledgement from us.

    Email: holiquin@comcast.net