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  Fax/Phone (407) 568-8418 ; www.mikendafarm.com
Summer Camp Registration Form

We are holding Summer Camp during the following weeks.   Please put the number 1 or 2 for your first and second choices!

__June 5-9 __June 12-16 __June 19-23 __June 26-30

Summer Camp ~ __Reg. $250 per week or __ $10 off Discount, $240 good thru May 1st or __ Student discount $225         Camp hours are 8:30 a.m. to 2:00 p.m.

Paying by check, please send in one-half deposit to Mikenda Farm prior to camp.   All deposits received are non-refundable.  Balance of registration fee due the first day of camp.

PARENT'S NAME _________________________________________________________

ADDRESS _________________________________________________________________

CITY____________________________ ZIP ______________

EMAIL ADDRESS____________________________________________

DAYTIME PHONE # _____________________ EVENING PHONE #_____________________EMERGENCY # _______________________

HOW DID YOU LEARN ABOUT US ______________________________________________________________________________________


Name of Child


Experience Around Horses

Name of Child


Experience Around Horses

LISTED BELOW ARE ANY HEALTH PROBLEMS OR CONDITIONS THAT SHOULD BE NOTED:__________________________________________________________________________________________________

The camp hours are 8:30 a.m. to 2:00 p.m. Parents who will have difficulty dropping off or picking up their child at those times can request extended hours for an additional hourly charge.  Please indicate here ________________________________________.

FOR AND IN CONSIDERATION OF THE ABOVE SERVICES, Equine Participant does forever and finally release, remise, acquit, satisfy and forever discharge Brenda Hagemeister DBA Mikenda Farm and those individuals listed as Mikenda Farm Instructors of and from all manner of action and actions, cause and causes of action, suit, debts, dues, sums of money, bonds, billings, contracts, controversies, agreements, promises, damages, variances, judgments, executions, claims and demands whatsoever, in law or in equity, which may arise or might in the future arise or hereinafter may arise for or against Brenda Hagemeister DBA Mikenda Farm and those individuals listed as Mikenda Farm Instructors for the services stated above.

This document is meant to be a full and complete release from any and all liability that may arise from instructing the Participant on how to properly ride, manage and care for horses. This release is given freely and voluntarily by the Participant and is meant to remain in existence throughout the duration of any instruction.

WARNING: Under Florida law, an equine activity sponsor or equine activity professional is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities.

___________________________________________           ____________
PARENT'S SIGNATURE                                                                 DATE

Please print this form and fill out completely, then return form with your payment to:

4740 Lazy H Lane, Christmas Fl 32709
Fax/phone(407) 568-8418
email: mikenda@aol.com


Last Updated:
© 2015 Mikenda Farm