Shea Rose Farm Summer Camp Registration Form


Camper's Name: ______________________________________________________________


Parent's Names: _______________________________________________________________


Email Address: ________________________________________________________________


Home Address: ________________________________________________________________


___________________________________________________________________________


Cell Phone Number: _______________________________________________


Home Phone Number:______________________________________________


Describe previous riding/vaulting experience:____________________________________________________________________


_____________________________________________________________________________


_____________________________________________________________________________


List weeks you wish to attend (see schedule on the Shea Rose Farm Camps page. Space is limited. If we can accommodate your rider, email notification will be sent to the above address:   _______________________________________________


Deposit (non-refundable, to be subtracted from the remainder of the camp fee due on the first day of camp) $100/rider or vaulter. Deposit enclosed? ______________


Release form with both parent's signatures enclosed with this registration form (available in forms on this website) unless already submitted? _________________


Shea Rose Farm policy read and form signed? ________________


Any medical issues that we need to be advised of?  __________________________________


___________________________________________________________________________


Send form with payment (Check made out to Shea Rose Farm or bank check) to:


Shea Rose Farm

2411 Waxhaw Marvin Road

Marvin, NC 28173


You may also copy and send to: shearose@mindspring.com  and drop by a check.






SHEA-ROSE FARM