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:  and drop by a check.