Summer Camp Application Form -2010

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Background Information

Name______________________________________ Age________  Birthdate ____________________

Street _________________________________ City_______________ State____ Zip ______________

Parent/Guardian _________________________ Home Phone ___________Work Phone___________

Cell Phone____________

Medical Concerns ____________________________________________________________________

Riding Experience (Circle appropriate level):     None        Beginner        Intermediate       Advanced

Sessions Requested (Check all that apply)

June 14-18___ June 21-25___   June 28-July 2___   July 5-9____ July 12-16__   July 19-23___   July 26-30___ Aug 2-6___   

Extended Care Required?  AM_____ PM_____

7:00 AM-9:00 AM $20.00/week   4:00 PM-6:00 PM $20.00/week    

Session Fee Schedule

One week: $275/week

 Two,  three, four, five, or six weeks: $250/week

Seven or eight weeks: $200/week

Amount enclosed __________________ Make checks payable to "MerryMount"

Mail to: MerryMount Equestrian Center, 8801 Frank Tippett Rd, Upper Marlboro, MD 20772

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