Youth Camps for Girls
Application
Please copy and paste this form into our contact form or you can print it off and send it directly to us.
Cost: $50 per person per camp. $25 is due 4 weeks prior to your camp to reserve your child/teens place and in non-refundable. Scholarships are available. All meals are provided. You may bring snacks to share if you would like. Limit: 12 girls per camp All campers are required to wear a helmet when riding.
Please mark the camp you would like to attend. Age groups are approximate.
June 11-13, 2010 Camp-Girls ages 15 to 18 __
July 9-11, 2010 Camp-Girls ages 11 to 14__
August 13-15, 2010 Camp- Girls ages 7 to 10__
Participant's Full Name: ___________________________________________________
Parent(s)/Legal Guardian(s):_______________________________________________
DOB: ________________________________
Age As Of the first day of camp: ______________
Height: ______________________________
Weight: _____________________________
Street Address:_________________________________________ Apt# ___________
City: _______________________________
State: ______________________________
Zip: ________________________________
Home Phone#: ( )_____________________
Cell Phone#: ( )_______________________
Parent Work Phone#: ( )________________
E-mail_________________________________________________________________
Employer/School: _______________________________________________________
Church You Attend: ______________________________________________________
How did you hear about Destiny Youth Ranch?:
____________________________________________________________
____________________________________________________________
PHOTO RELEASE:
I consent to and authorize the use and reproduction by Destiny Youth Ranch of any and all photographs and any other audio/visual materials taken of me for promotional material, educational activities, exhibitions, or for any other use for the benefit of the program.
Signature of Applicant: ___________________________________________________
Signature of Parent/Legal Guardian:_________________________________________
Date: ___________________________
(Parent/Legal Guardian must sign for participants under the age of 18)
______I have enclosed a check/cash for $______
______I have filled out the Application Form
______I have enclosed the 'Authorized for Emergency Medical Treatment' Form
______I have enclosed the Release and Waiver Form
______I would like more information on available scholarships for the D.Y.R. Program