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Registration Form

One rider per form, please.

Questions?
Call Donna at 603-568-8482
or
email paintedblessings@tds.net

I am registering for:
• Spring Camp • Summer Camp    
Camp April 25 - 29, 2016
June 27 - July 1, 2016
 
 
July 11 to 15, 2016
 
 
July 25 to 29, 2016
   
 
August 8 to 12, 2016
   
Rider's First Name: Rider's Last Name:    
Age:        
Street 1: Street 2:    
City: State:    
Home Phone: Cell Phone: Zip:
Email:        

If rider is under 18, please fill in this section
Mother's First Name: Mother's Last Name:    
(If different than rider's, address for mother)
Street 1: Street 2:    
City: State:    
Home Phone: Cell Phone: Zip:
Email:        
 
Father's First Name: Father's Last Name:    
(If different than rider's, address for father)
Street 1: Street 2:    
City: State:    
Home Phone: Cell Phone: Zip:
Email:        
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