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

July 18 - 22

July 25 - 29

Aug. 8 - 12

Aug. 15 - 19

Sessions 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