Youth Riding Camp Registration

Please select your camp date:(Required)

Youth Riding Camp: June 8-12

Youth Riding Camp: July 27-31

Youth Riding Returner Camp: August 3-7

Parent Info

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Cell Number(Required)

Camper Info

Rider Name(Required)

First Last

Child's Birthday(Required)

Shirt Size(Required)

Height(Required)

Weight(Required)

Must be under 200lbs

Years of Riding Experience, If Any(Required)

Brief Description of the Rider’s Horse Experience, If Any(Required)

What are the rider’s goals during the camp?(Required)

Emergency Contact Information

Emergency Contact (1)(Required)

First Last

Relation to Camper(Required)

Cell Phone(Required)

Alternate Phone

Emergency Contact (2)(Required)

First Last

Relation to Camper(Required)

Cell Phone(Required)

Alternate Phone

Youth Rider Health Information

Health Insurance Provider(Required)

Policy Number(Required)

Primary Care Physician's Name(Required)

Primary Care Physician Phone(Required)

Preferred Medical Facility(Required)

Date of Last Tetanus Shot(Required)

Current Medications(Required)

Allergies Including Medications(Required)

Special Dietary/Health Needs

Please provide any additional health related information we need to know

Registration Policy

Parent/Legal Guardian Name(Required)

Participant Name(Required)

Under Kentucky law, a farm animal activity sponsor, farm animal professional, or other person does not have the duty to eliminate all risks of injury of participation in farm animal activities. There are inherent risks of injury that you voluntarily accept if you participate in farm animal activities.