.                                         BREEZY BLUFF RIDING ACADEMY DAY CAMP    2016

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 _____

 2NDCAMPER’S NAME_______________________ AGE _____  $10 off   siblings

 3RD CAMPER’S NAME ______________________ AGE _____   $10 off   siblings

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       28 ____                                   11-3           ages 7-18
PONY CAMP     TBA                                                               9-12         ages 6-11
SUMMER         JULY  17__  18____ 19___ 20____             9am- Noon ages 7-adult
DAY CAMPS      JULY  24___25____  26___27_____
PLEASE REMEMBER YOU ARE SUBJECT TO THE ILLINOIS EQUINE LIABILITY LAWS
                                                                                                           sibling  
(non-refundable)                                                                                           
ENCLOSED       FEE   SPRING BREAK  CAMP  $80           ………..………… ..$________________(+ $70)
ENCLOSDED       FEE  1 DAY of SUMMER CAMP  $100    ……..………….  ..$________________(+$90)
ENCLOSED       FEE  ENTIRE SUMMER DAY CAMP    $375   ........................$________________(+$365)
ENCLOSED     FEE PONY CAMP   $125/2 days                 .................... ........$______________   (+$140)
ENCLOSED    FEE PONY CAMP   $75/1 day                      .............................$ ______________  (+$65)
BBRA STUDENT CAMP    $50 ONE DAY $125 3 DAYS     ..............................$ _______________ ( +$100)
TOTAL                                                                    ...........................................$_________________
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