Spring Horse & Farm Camp

Spring Horse & Farm Camp

Join us for our InStride Equestrian Center's Spring Break Horse & Farm Camp happening March 14 - 17 from 9:00 AM until 1:00 PM. Complete the form below to request a space for your child in our program. Campers will be selected on a first-come-first-serve basis. You will be notified by our staff if your child's space is secured. NOTE: If we reach our capacity, your child's name will be put on our waiting list. Please contact our Program Director, Diana Bregman with any further questions at (941) 412-9333.
Camper Information
Name *

First Name Last Name
Birthdate *

Month Day Year
Date
Grade *
Gender *

Female Male Other
Does your child currently attend the InStride Riding Academy? *

Yes No
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent Information
Parent #1 Full Name *

First Name Last Name
Parent #1 Cell Number *
Please enter a valid phone number.
Parent #1 Alt. Number
Please enter a valid phone number.
Parent #1 Email *
example@example.com
Parent #2 Full Name

First Name Last Name
Parent #2 Cell Number
Please enter a valid phone number.
Parent #2 Alt. Number
Please enter a valid phone number.
Parent #2 Email
example@example.com
Emergency Contact Information
Emergency Contact Full Name *

First Name Last Name
Emergency Contact Relationship to Camper *
Emergency Contact Cell Number *
Please enter a valid phone number.
Emergency Contact Alt. Number
Please enter a valid phone number.
Camper Health Information
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Is the camper prescribed an inhaler? If yes, please explain any instructions. *
Consent
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by InStride Therapy and Equestrian Center during the selected camp. In exchange for the acceptance of said child’s candidacy by InStride Therapy and Equestrian Center, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless InStride Therapy and Equestrian Center and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against InStride Therapy and Equestrian Center including all instructors, camp counselors, affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Medical Release and Authorization As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to InStride Therapy and Equestrian Center and its affiliates including Directors, Instructors, and Camp Counselors to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the Spring Horse & Farm Camp session. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Spring Horse & Farm Camp

Camper Information

Parent Information

Emergency Contact Information

Camper Health Information

Consent