Registration Form
 
 
* = Required Fields
Please enter your contact details
Name*:
 
Email*:
Age:
Date of Birth:
Gender:
Phone (home):
Phone (work):
School:
Name & Contact information
in case of emergency:
Riding Experience
Kayaking Experience
Has your child any special
requirements? Eg: asthma,
allergies, bedwetting, diet:
Medication: Is your child
taking any regular medication?:
List the name of the
medication & reason for
taking the mediaction:
Has your child attended
our camp before?:
Do you require bus transport
from Auckland? Please note
this is an EXTRA $25.00
My child agrees to abide by the camp rules. I agree that any serious
misconduct by my child will result in him/her being sent home at
my expense at any time. I give permission for my child, in the
case of accident or sickness to be taken to a Doctor at my expense.
I agree to the above:
Parent/Guardian Name:
Application Date:
Date of Camp:
Extra horse treks $10 each. Sorry, no EFTPOS or credit card facilities
available. Please send full payment along with your contact details
to: Lakewood Lodge, 585 Glen Murray Road, Huntly RD2
Bartercard welcome.
 
 
 
     



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