Please Fill out Form Medical Form - Int-Advance or Clinics Step 1 of 8 - Overnight Camp Enrollment Form 12% Pick which riding program student is enrolled in.* Int-Advance Clinic (Overnight) Day Lesson Program Pick which applies to Student* New Camper Returning Camper New Camper: First time student, or previous campers who did not participate in summer 2021. Returning Camper of 2021: Registration or login for students who participated in summer of 2021. Parent/Guardian Name* First Last Cell Phone*Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code HiddenPassword needed HiddenPassword RC* HiddenPassword New* Student's Name* First Last Student's Birthday* MM slash DD slash YYYY Student's age as of June 1st, 2022*910111213141516Student's height*3'8" - 3'11"4' - 4'4"4'5" - 4'7"4'8" - 4'11"5' - 5'3"5'4" - 5'7"5'8" - 6'Student's weight*50 - 60 pounds61 - 70 pounds71 - 80 pounds81 - 90 pounds91 - 100 pounds101 - 115 pounds116 - 130 pounds130 - 150 poundsKnown Allergies*YesNoAllergies*(check all that apply): Animals Insect Stings Medications Food Hay Fever/Pollen Plants Other Other/Specify Allergies:* Known Medical Conditions that could affect camper's riding* Medical InformationDoes your overnight camper take any medications?* Yes No Are they able to self-administer?* Yes No Medication*List any medications that the camper will need to take during camp. All medications must be in its original container and will be kept in the office during camp. Medication Name Dosage Frequency Purpose of Meds: MedicationList any medications that the camper will need to take during camp. All medications must be in its original container and will be kept in the office during camp. Medication Name Dosage Frequency Purpose of Meds: Medications allowed to be administered to my child during camp:*(check all that apply) Benadryl (allergic reactions) Tea Tree Oil (insect bites) Liquid Benadryl (skin allergies) Allegra Evening primrose oil for menstrual cramps Neosporin (skin) None Illnesses & Injuries*(check all that apply) Chronic or Recurring Illness or conditions that could affect riding: Asthma Constipation Bleeding/Clotting Disorders Diabetes Ear Infection Emotional Disturbances Fainting Hearing Impairment Nosebleeds Musculoskeletal Disorders Menstrual Cramps Wears glasses or contact lens Other None Specify Other Illness or Chronic Condition:* Anything you feel we need to know?* HiddenInsurance Information Insurance Name* Insurance Phone #*Policy Holder's Name* First Last Group ID#* Policy ID#* HiddenToday's Date MM slash DD slash YYYY Emergency ContactEmergency Contact Name* First Last Relation to Camper*GrandparentParentFriendOther RelativeEmergency Contact Phone*2nd Emergency Contact Name*(Other than name listed 1st one) First Last 2nd Emergency Contact Phone #Relation to Student (2nd Contact)* Important Safety Information*Horseback riding is a very physical outdoor recreational activity. For camper safety and the safety of others, participants must meet certain physical requirements to attend camp at M&M Ranch. Our camp is designed for our campers to ride in groups. Campers must be in good physical shape and not have any conditions that may affect their ability to participate in all camp activities. These include but are not limited to items such as arthritis, excessive weight, back or neck pain, decreased motor skills or other physical issues that may contribute to a difficulty balancing, staying seated, holding the reins or controlling a horse. Campers must be able to mount and dismount a horse without assistance (Instructors will help younger campers). Campers must be able to meet the rigors of riding, including dismounting the horse without stirrups. Campers must have the ability to independently remain seated and balanced on a horse in motion while simultaneously directing a horse's travel and speed for at least 1-2 hours. Campers must be able to withstand summer exposure to the outdoors, including hot, cold and or wet weather for a period of at least 2 hours. For the safety of all campers, we do not offer services for special needs riders. We recommend that you visit R.O.C.K. - Ride On Center for Kids which specializes in special needs riders. We are not set up to have one on one instruction with riders who have special physical or emotional limitations. Thank You! I have read and understand the Important Safety Information on attending summer camp at M&M Ranch. Do you have balance Due?* Yes No Balance Due PaymentBalance Due* Price: Cancellation Policy - Full*If for some reason, (e.g. emergency), you need to cancel your child’s camp the following conditions apply: Camp payment is non-refundable. If you have an emergency and need to cancel your child’s camp session, please email us. We do not offer refunds for any reason. Your enrollment for camp will not be complete until we receive all required forms. I have read and understand the Payment, Cancellation, Refund Policy on attending summer camp at M&M Ranch. Process Fee* Price: $0.00 Total $0.00 Credit Card*Card Details Cardholder Name Important*Submitting your enrollment may take a few moments. Don't refresh or close the page after you make your payment. After you make the payment it will take you to our website. Yes, I understand CommentsThis field is for validation purposes and should be left unchanged.