ROCKIN’ B HORSE CAMP PARTICIPANT INFORMATION


Liability release for RBRC
Click Here to Download
***All parent(s) must print and fill out the Liability Release form and return to RBRC***

Please Read the follow AS 09.65.145 & AS 09.65.290
* Required fields
E-mail Address: *
Parents Names:
Father: * Mother: *
Address: *
 
Fathers Employer: Mothers Employer:
Home Phone Number: *
Cell Phone: Cell Phone 2:
Camper Name: *
Age: * Grade School:
Additional Camper Name
Age: Grade:
Additional Camper Name
Age: Grade:
Camp(s) or Lesson You are Registering For: Please check all that apply *
Camps
Full Day Week-Long Camp Half Day Week-long Camps
1 Day Camp Kinder-Camp
Lessons
Single Lesson Group Lesson
Date(s) Desired: *
Health Insurance Company: *
Doctor/Clinic: *
Phone: *
Emergency Contact if parent not available:
Emergency Contact Phone Number:
Medical conditions, medications or other information RBRC should know about your child(ren):
Riding Experience: Please decribe in detail your child(ren) riding experience.
Comments/Questions:
Verification Code:
Enter Verification Code: *

***Please only hit the submit button once you have insured all required field are filled out, pressing the submit button more then once
could delay your registration process with RBRC, Thank you***
* Required fields