Mommy and Me Camp Registration

Please complete and submit the registration form below to proceed with your purchase.

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. In order to reserve your spot, you will need to complete your purchase after completing this registration.

Please note:


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: .


Hospital of choice:

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