.                                         BREEZY BLUFF RIDING ACADEMY DAY CAMP    2021

Please return form and fees to:
Breezy Bluff Riding Academy
3634 N 685 East Rd , McLean IL 61754  (309) 826 8999

Waiver Form must accompany Reservations

CAMPER’S NAME____________________________AGE _____

2ND CAMPER’S NAME_______________________ AGE _____  sibling discounts

3RD CAMPER’S NAME ______________________ AGE _____  sibling discounts

PARENT’S NAME __________________________________________

ADDRESS _____________________________________________________

CITY ____________________________ZIP _____________

PHONE     ____   _____________E-MAIL_______________________
special needs :            please note on back side
Emergency Phone to call during camp?             (  ___  ) _____________________   

SPRING Break     
March 24                                                       1:30-4                 ages 6-adult
Thur Camps     JULY 8____15____22____29  ____                 11-1          ages 6-16
PONY Camp      June 17___ & 18 ____
                                    10-11:30    ages 4-10
SUMMER  CAMP      JUNE  21__  22_23_24_25__  
                  11-4           ages 6-adult
HOME SCHOOL CLASS   May 6__ 13___ 20__27__                     10-11 am   school ages
SHORT COURSE CLASS  Sept 9 - Oct 28                                        1-3 pm     school ages-adult
PLEASE REMEMBER YOU ARE SUBJECT TO THE ILLINOIS EQUINE LIABILITY LAWS
                                                                                                                                                   siblings  
(non-refundable)                                                                                           
ENCLOSED           FEE   SPRING BREAK  CAMP  $8
0            ………..………$______________    
ENCLOSED          FEE  PONY CAMP $80 two days                         .............. $ ______________  (+$75)
ENCLOSED         FEE PONY CAMP $50 one cay                                      ......$______________   (+$45)
ENCLOSED        FEE  1 DAY of SUMMER CAMP   $100              ……..……   $_______________(+$95)
ENCLOSED       FEE  ENTIRE SUMMER DAY CAMP I    $400  .......................$_______________(+$395)

ENCLOSED     FEE Thurs  CAMP   $75/1 days                   .................... ........$_______________(+$70)
ENCLOSED     FEE Thur CAMP     $200/4day                      .............................$ ____________ _  (+$185)
HOME SCHOOL SESSIONS    $100    all 4                                .......................$ _______________(+$95)
HOME SCHOOL SESSION  $35 one session                          ........................$ _______________(+$30)
                
TOTAL                                                                    ........................................... $_________________
I give my permission to have this child treated medically if needed

________________________________________________
                                                                                                          parent or guardian
I do have medical insurance my card and policy information is :   

Co.

_______________________________________

                                                                                  
Policy # ___________________________________
http://www.BreezyBluffRidingAcademy.com                                                                                      
                                                            “To   God be the Glory"
first come first served all camps have a maximum #, payment must be in 2 weeks prior to camp
dates at latest place is not secured till payment is received