Sorry, all of our pony camps are full for the season

If you would like to register for a pony camp, please complete our online registration form below. Then, we will call you soon to answer any questions or for the required deposit.

If you would like to get more information about our Pony Camps before you fill out your registration form, contact us here or give us a call at(816)761-1234

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Camper Information

Desired Pony Camp Session *

Name *

Birthdate *

/ /

Age *

Gender *

Does your child...

Have any physical conditions or disabilities, which we should be aware of *

Please Explain

Have any allergies *

Please Explain

Take any medications *

Please Explain

T-Shirt Size *

Contact Information

Contact Person *

Name *

Email *

Street Address *

City *

State *

Zip *

Home Phone *

Business Phone

Cell Phone

Emergency Medical Consent

This consent gives permission for medical care in parental absence and must be presented upon admission for treatment. Every effort will be made to notify the parent or guardian immediately in case of emergency, illness, or injury. In the event that the parent cannot be contacted or arrive at Faulkner's Ranch in ample time, the child will be transported by Ambulance in an emergency situation. In a non-emergency situation the child will remain at Faulkner's Ranch until a parent or guardian can arrive.

In the event that my child requires medical or surgical care while I am unable to be reached, I hereby give my consent to medical or surgical treatment.

Please check the box below to show that you agree to the terms of this Emergency Medical Consent. Then, please type your name in the box below

Do you agree to the terms of the Emergency Medical Consent *

I Agree

Name Of Guardian *

Health Insurance Information

Health Insurance Company *

Name Of Policy Holder *

Policy Number *

Secondary Contact

In case of an Emergency and guardian can not be reached, notify: (someone other than yourself)

Name *

Home Phone *

Work/Cell Phone

Name Of Child's Physician *

Phone Number *

Name of Child's Dentist *

Phone Number *

Security Code: *

Please type the characters that you see in the box below.
This is to cut down on the number of SPAM messages that we recieve.

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