Name__________________________________________

Address________________________________________
    
           _________________________________________

Phone__________________________________________

Email__________________________________________

Date of Birth___________________  Age_____________

Contact in Case of Emergency: _____________________

Emergency phone: _______________________________

Riding Ability: never, a few times, beginner, intermediate, advanced

Attended last years camp:  yes   no

Medical Concerns_________________________________________

Any other Concerns_______________________________________


Christian Fellowship Ranch
369 Split Rock Rd.
Syosset, NY 11791
(516) 922-7712

Aug. 15 - 19
Session Registering for:
Please Print this form, fill out, & return with $50. Deposit for each week of enrollment to reserve space. Make checks payable to: Christian Fellowship House. No refunds after June 1st.
Christian Fellowship Ranch
369 Split Rock Rd.
Syosset, NY 11791
(516) 922-7712
Pam, Steve, Sharon and Michelle Horvath
cfranch369@aol.com
516-922-7712
Website:  www.christianfellowshipranch.com
2016