New Student Enrollment Form Step 1 of 4 - Overnight Camp Enrollment Form 25% Parent/Guardian Name* First Last Cell Phone*Email* Student Name* First Last Student Birthday* Student's Age*567891011121314Student Grade*K1st2nd3rd4th5th6th7th8thPrevious Riding Experience*None0-5 hours (walk only)5-20 hours (walk only)5-20 hours (walk,trot)20+ Rider able trot, lope on their ownCurrently taking Lessons 2-4 times/month, trot, lope on their ownNot taking lessons ride 3-4 times/month, trot, lope2nd Phone #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 Known 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*How did you hear about us?*FriendRelativePrevious CamperCamp Advertising SiteSearch on InternetotherWhich website did you hear about us?*Please describe riders experiences*If no experience write - none Important Safety Information*Horseback riding is a very physical outdoor recreational activity. For student safety and the safety of others, participants must meet certain physical requirements to attend camp at M&M Ranch. Our lessons is designed for our students to ride in groups. Students 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. Students must be able to mount and dismount a horse without assistance (Instructors will help younger students). Students must be able to meet the rigors of riding, including dismounting the horse without stirrups. Students 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. Students 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 students, 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 riding lessons at M&M Ranch. Medical InformationInsurance Name*Insurance Phone #*Policy Holder's Name* First Last Relation to Camper*GrandparentParentFriendOther RelativeGroup ID#*Policy ID#*Emergency Contact Name*(Other than parent listed on enrollment form) First Last Emergency Contact Phone*Relation to Student*Specify Other Illness or Chronic Condition:* PaymentMonthly Lesson Packages We offer*Intro LessonGroup LessonGroup Lessons (7yr and up): 50 min riding, 15/20 min tacking/grooming/caring of horses. ** In a group lesson if only one student is able to attend then they will have a 30 minute private lesson. ** Lessons for 5-6 years old: Semi-Private: (up to 2 kids) 30 minute lesson (includes grooming their horse) **Payment Online – First Month Tuition & Deposit Required** For Pricing on monthly packages ask us. I understand late fee will be applied if not paid by 1st of month.*YesAre you bringing your own horse?*NoYesCheck any that applies for your horse..* Very good ground manners Walk, Trot and lope no problem Ties well does not set back Well manner for farrier Gets the correct lead Kicks other horses while being ridden Bites other horses while being ridden Bucks every when ridden Bucks when not ridden consistently Does not rear Rearing is an issue Bringing Your Own Horse Policy*List of Requirements: broke, well behave, healthy, must be in condition to handle full week of camp. Copy of Current Coggin,Vaccines, Teeth floated at least within last 8 months Current on feet care & recent exam for any pain. Health Certificate (within 30 days coming to the Ranch) I have read and understand requirement bringing my own horse. Total $ 0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Billing 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 Cancellation & Make Up Policy*Cancellation Policy: If taking monthly lessons, One make-up per 2 month is allowed and must be taken w/in 30 day or forfeited. (There are no refunds for missed or being late for lessons) Please notify us by email within 48 hours of needing to cancel or lesson will be forfeited. We do not do make-up for bad weather days, since we provide barn lesson. If M&M ranch determines that lesson will need to be cancel then we will schedule a make-up day. Please see M&M Ranch Lesson Policy for rescheduling/make-ups. There is no refund once payment is made. I have read and understand the Payment, Cancellation, Refund Policy on attending summer camp at M&M Ranch. EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.