Youth Camps for Girls
 Application 2012

Please copy and paste this form into our contact form or you can print it off and send it directly to us. 

Cost: $75 per person per camp. $35 is due 4 weeks prior to your camp to reserve your child/teens place and is non-refundable. Scholarships are available. All meals are provided. You may bring snacks to share if you would like. Limit: 24 girls per camp All campers are required to wear a helmet when riding.
Please mark the camp you would like to attend.  

June 8-10, 2012 Camp-Girls ages 7 - 18 __
June 29-July 1, 2012 Camp-Girls ages 7-18__
July 20-22, 2012 Camp- Girls ages 7 - 18__
August 10-12, 2012 Camp-Girls ages 7-18___


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