Saddle Up Harrisburg · Equestrian Summer Day Camp

Camp Information

Eligibility: Campers must be between the ages of 7 and 14 as of June 22, 2026. Completion of this application does not guarantee enrollment. Accepted applicants will be notified within 2–3 weeks of the application deadline.

T-Shirt Size *

How Did You Hear About Saddle Up?

Camper Personal Information

First Name *

Last Name *

Date of Birth *

Age *

Gender

Home Address (Street) *

City *

State *

ZIP Code *

School Name

Current Grade

Household & Guardian Information

Primary Parent / Guardian

Full Name *

Relationship to Camper *

Primary Phone *

Email Address *

Employer / Occupation

Secondary Parent / Guardian (if applicable)

Full Name

Relationship

Phone

Email

Custody / Household Notes (optional)

Emergency Contacts

Please provide at least two emergency contacts who are NOT the primary guardian and can be reached during camp hours (8am–3pm, Monday–Friday).

Emergency Contact 1

Full Name *

Relationship *

Primary Phone *

Alternate Phone

Emergency Contact 2

Full Name

Relationship

Phone

Persons Authorized to Pick Up Camper (list all names) *

Persons NOT Permitted to Pick Up Camper (if applicable)

Medical & Health Information

Healthcare Provider

Physician / Doctor Name

Physician Phone

Insurance Carrier

Policy / Member Number

Allergies

Does the camper have any known allergies? (food, environmental, insect, medication, animals, etc.) *

Describe all allergens, reactions & severity *

Carries EpiPen?

Carries Inhaler?

Medications

Is the camper currently taking any medications? *

List all medications, dosage, frequency, and purpose *

Medical Conditions

Does the camper have any chronic or significant medical conditions? *

Describe all conditions in detail *

Dietary & Physical

Does the camper have any dietary restrictions or food preferences?

Please explain *

Does the camper have any physical limitations or mobility concerns?

Please explain *

Can Camper Swim?

Date of Last Tetanus Vaccine

Any recent surgeries, injuries, or hospitalizations in the past 12 months?

Please explain *

Special Needs, Accommodations & Program Questions

Saddle Up Harrisburg is committed to creating an inclusive experience for all campers. Please share any information that will help us best support your child.

Does the camper require any special assistance, accommodations, or support? *

Please describe in full detail *

Does the camper have an active IEP (Individualized Education Program) or 504 Plan?

Describe relevant accommodations from the plan *

Behavioral / Social Notes (optional)

Equestrian Experience

Does the camper have any prior experience with horses or equestrian activities?

Please describe their experience & skill level *

Program Questions

Why does your child want to attend Saddle Up Harrisburg? *

Applying for Financial Assistance / Scholarship?

Parent / Guardian Willing to Volunteer?

Additional Comments or Information (optional)

Agreements & Parent/Guardian Signature

Please read each agreement carefully. All boxes must be checked before the application can be submitted.

Liability Waiver & Release

I understand that participation in equestrian activities involves inherent risks including, but not limited to, falls, kicks, bites, and unpredictable animal behavior. I voluntarily consent to my child's participation and hereby release Project Cultivate, Inc., Saddle Up Harrisburg, their staff, volunteers, and partner organizations from any claims, liability, or damages arising from participation in camp activities, except in cases of gross negligence.

I have read and agree to the above

Photo & Media Release

I grant Project Cultivate, Inc. permission to photograph and/or video record my child during camp activities. These images may be used for educational, promotional, and social media purposes. No full names or personal identifying information will be shared without additional written consent.

I have read and agree to the above

Camp Rules & Code of Conduct

I agree that my child will follow all camp rules, respect staff, volunteers, fellow campers, and animals at all times. I understand that disruptive, unsafe, or disrespectful behavior may result in removal from the program without refund. I commit to ensuring my child arrives on time, properly dressed, and prepared for daily activities.

I have read and agree to the above

Medical Emergency Authorization

In the event of a medical emergency, I authorize Project Cultivate, Inc. staff to seek emergency medical treatment for my child if I cannot be reached. I understand that all medical costs are the responsibility of the parent/guardian. I confirm that all medical information provided in this application is accurate and complete to the best of my knowledge.

I have read and agree to the above

Electronic Signature

Parent / Guardian Printed Full Name *

Date *

By typing your name above, you confirm that you are the parent or legal guardian of the applicant and that all information provided is accurate and complete.