Name of Student ____________________________________OHIP Number_______________

Name of Guardian ___________________________________Birth Date__________________

Address________________________________________________________________________

Telephone Numbers:

Home:____________________________________________

Office Mother :_______________________Office Father:______________________________

Mother Cell: ___________________________Father Cell: _____________________________

Family Physician : _______________________Phone : ____________________________

Allergies : _______________________________________________________________________

Previous Riding Experience:

_______________________________________________________________________________

_______________________________________________________________________________

Circle the week you are Applying for :

Camp Weeks
July 5-9
July 12-16
july 19-23
July 26-30
Aug 9-13
Aug 16-20
Aug 23-27

Total payment for 5 day Camp 250.00 plus applicable tax (Deposit 60.00 with application)
(Website will be updated with tax info once legislation has been passed with regard to HST
Please make cheques payable to Trilliumview Stables
No charge for helmet rental but please come and reserve yours in advance.