Mommy and Me Camp Registration

MOMMY & ME CAMP AGES 3 & 4 - REGISTRATION FORM

Camp runs 9:30AM to 11:00AM
$50.00 PER COUPLE

Camp date you selected to book:*

*Note: This form is not a reservation for camp. You cannot select a new date from this form. In order to reserve your spot, you will need to complete your purchase after completing this registration.

Please note:
Payments are non-refundable unless the camp is canceled by Kraus Farms.
Kraus Farms reserves the right to cancel any camp due to low attendance.

GUARDIANS NAME: AGE:
CAMPERS NAME: AGE:
EMAIL:
ADDRESS:
PHONE #:

Emergency Contact:
Relationship:
Emergency Contact Phone #:
Alternate Phone #:

Physician Name:
Physician Phone #:

My child is covered with insurance.
Policy #
Group #:
Insured’s name: .

I give permission for my child to be treated at the hospital if I can not be reached in the event of an emergency.
Hospital of choice:
I assume all financial responsibility for any medical treatment and transportation.

BY SIGNING BELOW YOU:

• Consent to receiving electronic communications from us.

• Agree that electronic communications have the same effect as if provided to you on paper.

• Agree that your electronic signature (via filling in your name below and submitting this form) in connection with agreements and other communications has the same effect as an ink signature.

• Confirm that you are authorized to provide this consent on behalf of yourself and your child and/or legal ward.

Parent or Guardian Signature: Date:

KRAUS FARMS EQUESTRIAN CENTER
333 HILLSBORO RD. ST. LOUIS, MO. 63049
(636)225-9513 or visit us at www.krausfarms.com

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