Name__________________________________________
Address________________________________________
_________________________________________
Phone__________________________________________
Email__________________________________________
Date of Birth___________________ Age_____________
Contact in Case of Emergency: _____________________
Emergency phone: _______________________________
Riding Ability: never, a few times, beginner, intermediate, advanced
Attended last years camp: yes no
Medical Concerns_________________________________________
Any other Concerns_______________________________________
Christian Fellowship Ranch
369 Split Rock Rd.
Syosset, NY 11791
(516) 922-7712
Please Print this form, fill out, & return with $50. Deposit for each week of enrollment to reserve space. Make checks payable to: Christian Fellowship House. No refunds after June 1st.
Christian Fellowship Ranch
369 Split Rock Rd.
Syosset, NY 11791
(516) 922-7712
Pam, Steve, Sharon and Michelle Horvath
cfranch369@aol.com
516-922-7712
Website: www.christianfellowshipranch.com