subject_line
Wagon Wheel Pony Camp Registration
Camper First Name
*
Camper Last Name
*
Address
*
Address 2
City
*
State/Province
*
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
Zip/Postal Code
*
Phone
*
Email Address
*
Membership Type
*
Camp
Class
After School
Preferred way to contact
*
Phone
Email
Any
Terms and Conditions
*
You consent to receive communications from us electronically. We will communicate with you by e-mail or phone. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.
Please sign
*
clear
Credit card information/ Name on Card
Card Number:
*
Expiration Date:
Security Code:
Zips Code Associated With Card:
Choose Camp Week
*
Week 1 June 25th - June 29th ($449.99)
Week 2 July 5thth - July 7st ($349.99)
Week 3 July 17th - July 20th ($449.99)
Week 4 July 26th - July 28nd ($349.99)
Week 5 August 7th-August 10th ($449.99)
Choose Camp Week
Week 1 June 25th - June 29th ($449)
Week 2 July 5th - July 7th ($349)
Week 3 July 17th - July 20th ($449)
Week 4 July 26th - July 28th ($349)
Week 5 August 7th - August 10th ($449)
Week 6 August 1st - August 5th
Week 7 August 8th - August 12th
Week 8 August 15th - August 19th
Week 9 August 22nd - August 26th
Choose Camp Week
Week 1 June 25th - June 29th ($449.99)
Week 2 July 5th - July 7th ($349.99)
Week 3 July 17th - July 20th ($449.99)
Week 4 July 26th - July 28th ($349.99)
week 5 August 7th- August 10th ($449.99)
Choose Camp Week
Week 1 June 25th - June 29th ($449)
Week 2 July 5th - July 7th ($349)
Week 3 July 17th - July 20th ($449)
Week 4 July 26th - July 28th ($349)
Week 5 August 7th - August 10th (449)
Week 6 August 1st - August 5th
Week 7 August 8th - August 12th
Week 8 August 15th - August 19th
Week 9 August 22nd - August 26th
Choose Camp Week
Week 1 June 26th - June 29th ($449)
Week 2 July 5th - July 7th ($349)
Week 3 July 17th - July 20th ($449)
Week 4 July 26th - July 28th ($349)
Week 5 August 7th-August 8th ($449)
Week 6 August 1st - August 5th
Week 7 August 8th - August 12th
Week 8 August 15th - August 19th
Week 9 August 22nd - August 26th
Mother’s Full Name
*
Email Address
*
Phone Number
*
Father’s Full Name
*
Email Address
*
Phone Number
*
Emergency Contact Information Full Name
*
Emergency Contact Phone Number
*
Please State Any Medical Conditions Or Allergies We Need To Be Aware Of
*
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