Pets N People

Health and Wellness

Holistic Therapy for Prevention and Amazing Healing

Nature's Divine

opening the door to nature

Melissa Bieber

8495 Oak Lane, P.O. Box 8, Becker, MN  55308

320-267-8034

melissa@naturesdivine.net

Nature's Divine

opening the door to nature

Pets N People

health and wellness

2013 Summer Camps

Camp Registration Form

Please complete this information form with Payment and Waiver and send it to:

Melissa Bieber, P.O. Box 8, Becker MN 55308.

Each camp session is limited in size. Registration is subject to availability.

Camper Name: ____________________________________________________________________

Age: _____________ DOB: ___________Height and weight: ________________________________

Camp types and session dates that you wish to attend: 1st choice:_________ 2nd choice:__________

Have you previously attended a horseback riding camp? _______  Have you ridden before? _______

If yes, please describe your level of riding experience: ______________________________________

_________________________________________________________________________________

Do you have any medical situation of which we should be aware? ______  If yes, please describe: ________________________________________________________________________________

________________________________________________________________________________

If a Minor: Names of Parents/Guardians: ________________________________________________

Address: _________________________________________________________________________

Address:  ________________________________________________________________________

Cell Phone Numbers: _______________________________________________________________

Home Phone Numbers: _____________________________________________________________

E-mail Addresses: __________________________________________________________________

Emergency Contacts Names: ________________________________________________________

Address: _________________________________________________________________________

Phone Number: ________________________ Phone Number: ______________________________

Students will be working together in small groups. If you have a friend (or friends) who you would like to

be in your group, please list their name and age: ____________________________________________

___________________________________________________________________________________

How did you find out about our Camp?____________________________________________________

Signature (Parent/Guardian if Minor): ___________________________________  Date:____________

Thank you very much, we look forward to seeing you at Camp