Registration Form

You may complete this registration form, then copy and paste it into an email to Quiet Place Stables at quietplace@hotmail.com. A confirming email will be sent to you once your registration has been received. If an email is not received from Quiet Place Camp within 24 hours, please call our toll free number at 1-888-760-3010 to confirm registration. You may also use our "printer friendly" text version of this form by clicking here. Print it, fill it in and fax or mail with a deposit cheque to:

The Quiet Place Stables
General Delivery
Boulter, Ontario, Canada
K0L 1G0

Last Name:

First Name:

Street Address:

City:

Province/State:

Postal/Zip code: Country:

Parents Names:

Home Phone:
Business Phone:
FAX:

E-mail address:

Age:Date of Birth:

Gender:Height:Weight:

Health Card Number or Medical Insurance:

Citizens, other than Canadian, may be required to provide a credit card should medical attention be necessary.

Has your child ridden before?
Yes
No
If yes, where, when and how long?

Does your camper want to ride English or Western seat?

We like to start new riders with a Western saddle, and all new riders are taught the two handed method of riding.

What are your riding goals?

What are you looking forward to doing at camp other than riding?

Would you like to be in the same cabin as a friend? If so, please state name.

Does your camper have any special dietary needs, ie, food allergies, vegetarian?

Is transportation required to or from the Toronto or Ottawa Airports for your camper?
Yes
No
If yes, we will contact you with times and cost of transportation.

Indicate preferred dates by typing "yes" in your first choice box(es).

Week 1 - July 1 to July 7
Week 2 - July 8 to July 14
Week 3 - July 15 to July 21
Week 4 - July 22 to July 28
Week 5 - July 29 to August 4
Week 6 - August 5 to August 11
Week 7 - August 12 to August 18
Week 8 - August 19 to August 25
Week 9 - August 26 to September 1

Indicate second choice dates by typing "yes" beside the appropriate dates below.
Week 1 - July 1 to July 7
Week 2 - July 8 to July 14
Week 3 - July 15 to July 21
Week 4 - July 22 to July 28
Week 5 - July 29 to August 4
Week 6 - August 5 to August 11
Week 7 - August 12 to August 18
Week 8 - August 19 to August 25
Week 9 - August 26 to September 1

All campers receive a complementary Quiet Place Stables t-shirt. Please indicate your campers size by typing "yes" in the appropriate box:
Youth SmallMediumLarge

Adult SmallMediumLarge

How did you learn of our program?

I would prefer to pay the deposit of $200.00 Cdn. per week by :
Cheque (enclosed)
VISA
American Express
MasterCard
If paying by VISA, American Express or MasterCard, please complete the information below or call Quiet Place Camp toll free at 1-888-760-3010 with this information.
Credit Card #
Card Expiry Date
Name of Cardholder

I would prefer to pay the balance of camp fees by :
Cheque - Enclosed dated March 15 or dated May 15
VISA - Put through on, 2007
Amercian Express - Put through on, 2007
MasterCard - Put through on, 2007
If paying by Credit Card, please complete the information below or call Quiet Place Camp toll free with this information.
Credit Card #
Card Expiry Date
Name of Cardholder

Conditions of Registration:

I, the parent/guardian of the above-named participant, release Quiet Place Camp, its director, staff and agents from any loss, personal injury, accident, misfortune or damage to the above-named camper of his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the above-named camper.

The camp director reserves the right to dismiss a camper who, in the opinion of the director, is a hazard to the safety and rights of others or who appears to have rejected the reasonable controls of camp. No refund will be made for dismissals due to disciplinary action.

Each camper must be covered by Ontario Health Insurance or equivalent medical insurance. The parent/guardian certifies that the camper is in good health, normal in condition and habits, and is amenable to camp life. By signing this form the parent/guardian is giving the camp staff the right to obtain medical attention necessary for the camper's welfare and good health. The parent/guardian is responsible for all costs incurred. I hereby give permission for my son/daughter to participate in the entire program, and permission for Quiet Place Camp to act in my behalf in case of sickness or emergency. I give permission to Quiet Place Camp to use any photograph or video of my child for promotional material and that my positive statements about Quiet Place Camp may be used as testimonials in materials publicizing the camp program.

I have read and understand the contents of this application, including the Cancellation Policy, Payment Policy and Conditions of Registration. This application has my approval and consent:

Parent or Guardian

Camper

Dated day of , 2007

By submiting this Registration Form, I agree to the above statements. This stands as my signature to that effect.

To Enroll at Quiet Place Riding Camp

Email the above form to reserve your camper's spot. Please print and mail the completed, signed registration form including the required deposit ($200.00 per week) for the number of weeks your child will be visiting. Balance of fees are due by May 15. We will hold spaces for 7 days and confirm registration once your deposit has been received.

Deposits are non-refundable. The balance of camp fees will only be refunded if all spaces are filled in the session you wish to cancel. In the event that a camper cannot attend any session for medical reasons, a credit for the unused portion of their session will be granted to be used toward their camp fees for the following year, upon receipt of a doctor's certificate.

Pre-camp information and a suggested list of items to bring to camp will be mailed to you.

Number of Weeks	Regular Rate	Paid in Full by March 15
1 Week	$ 745.00	$ 680.00
2 Weeks	$1,450.00	$1,320.00
3 Weeks	$2,175.00	$1,980.00
Each Additional Week	$ 710.00	$ 645.00

All prices are in Canadian funds. 6% GST is to be added to fees.

Early Registrations

All "Paid in Full" registrations for any week(s) received by March 15th, will receive a $65.00 per week discount! (shown above)

Family Discounts

Families will receive a $25.00 discount on registration fees for the second or more child(ren).

The Quiet Place Stables
Summer Riding Camp
General Delivery
Boulter, Ontario
Canada
K0L 1G0

Camp Director: Jo-Anne Boyko

Toll Free: 1-888-760-3010
Local: 1-613-332-1735
Fax: 1-613-332-6416

Or email us here!

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All fees are in Canadian funds.
ADVANCED BOOKING IS REQUIRED