Full Name:       Age:
Street Address:
City, Prov:       
Postal Code:    
Home Phone:  
E-Mail address:
Birthdate:      Height:      Weight:
Family Doctor      Telephone #      
Health Card No.

Camper Experience (Please check off the most accurate description of your child’s riding experience and ability).
   Extreme Beginner - Has been on a horse less than 5 times.
   Beginner - Walk, stop and steer, some trotting.
   Novice - Walk, sitting and posting trot, some canter
   Intermediate – Walk, trot, canter with balance and control; some jumping
   Advanced - Walk, trot, canter and jump with confidence and accuracy

Do you have any medical conditions, learning disabilities, allergies or any other conditions we should be aware of? No   Yes 
If yes, please describe:

Select Session: 1^st choice    2^nd choice
 Signature of Parent/ Guardian:___________________________________________________________________

Full name of Parent/Guardian:______________________________________Phone # where Parent/Guardian can be reached during the day during camp:

Payment to accompany application form: 

For March Break Camp: Full payment  $315.00 (G.S.T. included) due at time of application.

For Summer Camps: A deposit of $100.00 payable on or before May 1, 2009 and a postdated cheque for $215 dated June 15, 2009.. 

For P.A.  Fun Days include a cheque for $73.50 (G.S.T. included) with application form.

Please make cheques payable to Dreamscape Farm  and mail to:    Dreamscape Farm
                                                                                                                      2696 11th Line  
                                                                                                                      RR#2 Bradford, Ontario
                                                                                                                      L3Z 2A5
                                                                                                                      905-775-4332