Pony Camp Week 1 June 8-11

Gargot Farms Camp Registration Form

These forms are required for your children to attend camp.
Camper's Information
Member ID
Camper Name
Nickname
Date of Birth

MonthDayYear
Age
NOTE - Camp is open for ages 6-13. Children need to have completed first grade before they are eligible to participate in Gargot Farms' pony camp.
Entering Grade in 2026/27
Camper Riding/Equine Experience

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Heading

Emergency Contact #1
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Relationship to Child

Medical / Health Information
Name of Physician or Clinic/Hospital
Phone Number
Format: (000) 000-0000.
Does your child have any food, medication or environmental allergies?
Allergies? Check all that apply
Please list and explain any allergies

0/150
Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?
Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?
Please explain

0/150

Payment and Statement of Understanding
Gargot Farms has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.
Type first and last name above to consent
Sign Document
Date Signed

MonthDayYear
Camp Director Name and Contact Info
My Products
prevnext( X )
Pony Camp Deposit
A deposit is required to hold a camper's spot. This deposit is ONLY refundable if your spot can be filled off of the wait-list. ***THIS DEPOSIT IS HALF OF THE TOTAL COST OF CAMP ($500). THE REMAINING COST IS DUE BY THE MORNING OF THE FIRST DAY OF YOUR CAMP WEEK***

$250.00

Total

$0.00
Payment Methods

Choose from one of the PayPal options to make your payment.
Should be Empty:

Gargot Farms Camp Registration Form