.                                         BREEZY BLUFF RIDING ACADEMY DAY CAMP    2019

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 _____  $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
W
ed Camps     JULY 10____17____24____31____
SUMMER         JU
NE  17__  18____ 19___ 20____             9am- Noon ages 7-adult
DAY CAMPS    JU
NE  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    $3
25   ........................$________________(+$315)
ENCLOSED     FEE W
ed  CAMP   $100/1 days                 .................... ........  $________________(+$90)
ENCLOSED    FEE W
ed CAMP     $185/4day                      .............................$ _____________ _  (+$175)
BBRA STUDENT CAMP    $50 ONE DAY $125 3 DAYS     ..............................$ _______________ ( +$1
15)
TOTAL                                                                    ...........................................$_________________
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