Participant Information

*First Name

*Last Name

*Gender

*Birth Date

*Grade

Household / Adult Primary Contact

Relationship to Participants: *

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

*Phone

*Mobile Phone

*Emergency Phone

Email Address *

Is your child on any medications ? *

0/500 characters

Does your child have any dietary restrictions? ( we cannot accommodate certain dietary restrictions or allergies, please contact us prior to sign up if your child requires a special diet or has a food allergy): *

0/500 characters

2017 Summer Resident Camp Options

Camp runs for a period of 9 weeks. Sunday June 25th to Sunday August 27th

Check your arrival and departure dates below.

Please Choose a Session: *

1st Session begins June 25th and ends (please choose one)

Session 1

2nd Session begins Jul 2nd and ends (please choose one)

Session 2

3rd Session begins July 9th and ends (please choose one)

Session 3

4 Session begins July 16th and ends (please choose one)

Session 4

5th Session begins July 23rd and ends (please choose one)

Session 5

6th Session begins July 30h and ends (please choose one

Session 6

1 week Aug 6th - $1650.00	2 weeks Aug 13th - $3,200.00
3 weeks Aug 20th - $4,750.00	4 weeks Aug 27th - $6,300.00

7th Session begins August 6th and ends (please choose one)

Session 7

1 week Aug 13th - $1650.00	2 weeks Aug 20th - $3,200.00
3 weeks Aug 27th - $4,750.00

8 Session begins August 13th and ends (please choose one)

Session 8

1 week Aug 20th - $1650.00

2 weeks Aug 27th - $3,200.00

9 Session begins August 20th and ends (please choose one)

Session 9

1 week Aug 27th - $1650.00

Enrollment Notes / Payment Plan Notes:
(space where you can input your payment plan notes, special enrollments etc)

2017 Activity Program Fees

Activity Fees cover most admissions to programs and are included in tution.

Excluded from Tuition Fees (these activities are extra):

Whitewater Rafting Excursion, The Bobsled Experience, Adirondack Extreme Zip Line

and Obstacle Course, Hungry Trout Fly Fishing, Lake Placid Flight Tours and more.

Included in Tuition:

Extreme Tubing by ADK Aquatics, extra horseback riding lessons, visits to adirondack museums, 46'r hiking trips, horseback trail rides by ADK Equine Center, Wilderness Paintball, Boots & Birdies Golf and more.

All programs have professional staff certified separately from ADK WildHorse Camp.

Preferred Discipline

(please check all that apply)

Western	English	Jumping
Dressage	Barrels	Vaulting

Payment Form

(please complete all fields)

Billing Information:

Payment Options:

Visa	Mastercard
Discover	Amex

First Name *

Last Name *

Credit Card Number *

Expiration Month *

Expiration Year *

CID Code *

Billing Address:

Street Address *

City *

State *

Postal Zip *

Country *

E-mail Invoice & Receipts to: *

Tuition Discount (siblings/friends: minimum 2 week sign up per child; early birds: check dates on website):

10% (Sibling / Sister)

Early Bird Discounts are featured on this page: Main Page

Friends & Sisters discount is featured on this page: Friends & Sisters

Enrollment Total:

$0.00

Cancellation & Refund Policy:

Is your child's tuition protected by A+ Insurance or by any other insurance company ? *

Yes, my child's tuition is protected by A+ Insurance or other insurance that covers tuitions

No, my child's tuition is not protected by A+ Insurance or any other insurance company

By checking this box, I acknowledge that I had the chance to review the A+ Program Protection Insurance and decided not to sign up for the service.

Cancellations, Refunds, Terms & Conditions:

Cancellation notice must be submitted in writing and mailed to the camp's mailing address.

Refund will be issued in the same manner as payment was made.

Deposits are not refundable

If issued, 80% of tuition paid will be refunded if written notice is received no later than nine weeks prior to start of camp. Start of camp is June 25th (individual enrollments only).

Cancellations received after April 1st, forfeit full tuition unless there is a valid health related reason for cancellation. All health related cancellations require a physician's written notice.

Enrollment cancellations after April 1st will not receive a refund. Some cancellations may qualify for the following year's Camp Credit. Please inquire with Stacy at info@girlshorsecamp.com

Cancellation due to severe illness or accident prior to camp session start date require a physician's written notice. After cancellation is reviewed, 80% of tuition paid will be refunded.

Cancellations due to personal reasons will not receive a refund.

Cancellations due to withdrawal, dismissal, transportation issues, changes to vacation plans and any other reasons will not receive a refund.

Campers or Trainees who leave during a session will not receive a refund.

Once a camper arrives at camp no refunds will be made for any reason

We reserve the right to dismiss any camper that is not compatible with the camp programs. The camper and the parent will forfeit any and all tuition.

We cannot offer discounts on late starts and early departures.

Omission of any pertinent information can be grounds for dismissal.

The camp cannot accommodate certain dietary restrictions.

If camper refuses to participate in off-camp activities, activity fees are nonrefundable

Tuition quotes do not include miscellanous charges unless noted otherwise (personal spending).

If paying by visa, mastercard, discover or amex, there is a 3% processing fee. To avoid this fee, a camper enrollment can be sent via UPS or Fedex (we do not recommend using USPS for sensitive information) to 776 County Route 18 Lake Clear, NY 12945 and the form can be accessed here: Mail in Resident Form

*

By checking this box I verify I have read and agree with the above cancellation & refund policy.

Signature *

clear

Today's Date: *

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1 week July 2nd - $1650.00	2 weeks July 9th - $3,200.00
3 weeks July 16th - $4,750.00	4 weeks July 23rd - $6,300.00
5 weeks July 30th - $7,850.00	6 weeks Aug 6th - $9,400.00
7 weeks Aug 13th - $10,950.00	8 weeks Aug 20th - $12,500.00
9 weeks Aug 27th - $14,050.00

1 week July 9th - $1,650.00	2 weeks July 16th - $3,200.00
3 weeks July 23rd - $4,750.00	4 weeks July 30th - $6,300.00
5 weeks Aug 6th - $7,850.00	6 weeks Aug 13th - $9,400.00
7 weeks Aug 20th - $10,950.00	8 weeks Aug 27th - $12,500.00

1 week July 16th - $1,650.00	2 weeks July 2rd - $3,200.00
3 weeks July 30th - $4,750.00	4 weeks July 6th - $6,300.00
5 weeks Aug 13th - $7,850.00	6 weeks Aug 20th - $9,400.00
7 weeks Aug 27th - $10,950.00

1 week July 23rd - $1650.00	2 weeks July 30th - $3,200.00
3 weeks Aug 6th - $4,750.00	4 weeks Aug 13th - $6,300.00
5 weeks Aug 20th - $7,850.00	6 weeks Aug 27th - $9,400.00

1 week July 30th - $1650.00	2 weeks Aug 6th - $3,200.00
3 weeks Aug 13th - $4,750.00	4 weeks Aug 20th - $6,300.00
5 weeks Aug 27th - $7,850.00