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Phelan Training Stable - Registration Form 2017

Child's Last Name: ___________________________________________________________________

Child's First Name: ___________________________________________________________________
Child's  Date of Birth : _________________________________________________________________
Parent/Guardian Last Name: ____________________________________________________________
Parent/Guardian First Name: ____________________________________________________________
Address: ___________________________________________________________________________
City/Town: _______________________________________________ Zip Code: __________________
Home Phone: __________________
Work Phone: ___________________
Cell Phone: ____________________
Emergency Contact: _____________________________________________________
Emergency Phone: ______________________________________________________
Does your child have special medical needs?  Yes     No
If yes, please describe: ________________________________________________________________

Please Circle which camp session you would like:

7/11-15

7/31-8/4

8/7 - 8/11


A copy of the Registration Form has been saved in a PDF file format and requires a copy of Acrobat Reader for viewing and printing. The majority of computers already have a copy of Acrobat Reader installed. If you do not presently have a copy of Acrobat Reader installed you may download a free copy at the Adobe website.

Adobe

DOWNLOAD REGISTRATION FORM

 | DAY CAMP | | REGISTRATION FORM | | RELEASE FORM |

PHELAN TRAINING STABLE - 2218 STATE ROUTE 444 - BLOOMFIELD, NY 14469 - 585-657-6952


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