Miracle Mountain Ranch Horse Camp Registration

Rancher's Name * First Last

Age at time of Camp *

Year of Last Tetanus *

Allergies/Restrictions

Please list any allergies or restrictions that may have an effect on your child's stay.
Please note we are not able to accommodate all food restriction.
Please call our office you you have questions or concerns.

Number of Years Previously Attended *

Group / Church Attending With

Roommate Request 1 (Only two please)

Roommates must be within two years of age, attend the same camp, and select each other in order for your request to be honored.

Roommate Request 2 (Only two please)

Roommates must be within two years of age, attend the same camp, and select each other in order for your request to be honored.

Parent/Guardian's Name * First Last

Spouse's Name First Last

Email *