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SUMMER CAMP
Mountain of Fun Summer Program Registration
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Name
This field is for validation purposes and should be left unchanged.
Student name as it appeared on your online check out
*
First
Last
Parent/Guardian 1
Parent/Guardian 1 Name:
*
First
Last
Relationship to student
*
Mother
Father
Stepmother
Stepfather
Guardian
Partner
Grandmother
Grandfather
Other
Address
*
Street Address
Address Line 2
City
State / Province / Region
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Does the student live at this address:
*
Full time?
Part time?
Primary Mobile Contact Number
*
Alternate Phone Number
Alternate Phone Number Type
Home
Work
Mobile
Email
*
Parent/Guardian 2
Parent/Guardian 2 Name:
First
Last
Relationship to student:
Father
Mother
Stepmother
Stepfather
Guardian
Partner
Grandmother
Grandfather
Other
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
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Algeria
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British Indian Ocean Territory
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Bulgaria
Burkina Faso
Burundi
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Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
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Colombia
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Congo, Democratic Republic of the
Cook Islands
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Croatia
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Curaçao
Cyprus
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Ethiopia
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Heard Island and McDonald Islands
Holy See
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Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
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Lithuania
Luxembourg
Macao
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Malawi
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Maldives
Mali
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Panama
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Poland
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Does child live at the address:
Full time
Part time
Primary Mobile Contact Number
Alternate Phone Number
Alternate Phone Number Type
Home
Work
Mobile
Email
Emergency Contacts
In addition to parents, to be called in case of emergency (must be 18 years of age or older)
Name
*
First
Last
Relationship:
*
Aunt
Brother
Father
Friend
Grandfather
Grandmother
Mother
Neighbor
Sister
Stepparent
Uncle
Other
Phone
*
Add Emergency Contact
Check to add an additional Emergency Contact
Name
First
Last
Relationship:
Aunt
Brother
Father
Friend
Grandfather
Grandmother
Mother
Neighbor
Sister
Stepparent
Uncle
Other
Phone
Medical Information
Does you child have medical insurance?
*
Yes
No
If YES, please specify the network name and primary policy holder member ID:
*
Does your student have any allergies or dietary restrictions (If YES, please list them)?
*
Legally, parents must give their written permission to MMS staff to dispense any form of medication. I authorize MMS staff to give my child the following:
Aloe Vera/Sun relief
Antihistamine
Chewable Antihistamine
Hydrocortisone Cream
Topical sting relief
Poison oak wash/lotion
Sunblock
Antibiotic ointment
Acetaminophen
Chewable Acetaminophen
Ibuprofen
Children's Aspirin
Throat Lozenges
Other
Specify:
*
Date of last tetanus shot
*
Please list any conditions which may require action (allergies, bee stings, asthma, diabetes, etc.)
In the case of most medical occurrences, parents or emergency contacts will be called to decide how to proceed. However, in the case of an emergency that requires immediate response:
*
I authorize MMS staff to arrange transportation to the nearest hospital in case of accident or acute illness and to arrange for possible emergency and/or surgical care under whatever conditions necessary to preserve the life, limb, or well-being of my child.
Yes
No
Is there any other important information we should know that will help us care for your child?
Permissions
I authorize MMS staff to arrange supervised walks during the camp day on the MMS property. I understand my child will return to MMS by regular dismissal time unless notified otherwise.
*
Yes
No
I authorize MMS to publish my child's photo, and/or video for summer camp marketing purposes online or in print. No name will be attached to pictures or videos.
*
Yes
No
Is your child registered for Horse Camp?
Yes
No
Horse Program Information
You have enrolled your child in Horse Camp. Please read and complete the
Mt. Madonna Stables liability waiver
and fill out the following fields. Please send a copy of the waiver before the first horse camp session.
Child's Height
*
Child's Weight
*
Horse Handling/Riding Experience
*
1st Time Rider
Less than 50 hours of lessons
More than 50 hours of lessons
Does this child have any physical or mental conditions that may affect his/her safety and ability to ride, drive, and/or train horses?
*
Yes
No
If "yes", how can we help this student with his/her special needs?
Please refer to the PDF waiver to agree to the following.
*
I understand that checking the following boxes constitutes a legal signature confirming that I acknowledge and agree to the Terms of Acceptance included in the
Mt. Madonna Stables liabilty waiver
Section B. Agreement, Scope, Definitions and California Jurisdiction
Section C. Inherent Risks/Assumption of Risks
Section D. Conditions of Nature Warning, Unfamiliar and Sudden Sights, Sounds, and Movements Warning, and Inspection of Premises
Section E. Saddle Girths/Natural Loosening Warning
Section F. Protective Headgear/Helmet Warning
Section G. Liability Release
Acknowledgement
*
We, the parents of the above named, for and in consideration of our child's participation in all activities of Mount Madonna Stables, state that we have read the waiver, release and hold harmless agreement written above and we expressly agree that the terms and conditions of said waiver, release and hold harmless agreement shall apply to and be binding upon us and our minor child in so far as it pertains to his or her participation and to any injury or damage said minor child, or his/her horse, may sustain or cause as a result of said participation.
I/We represent that I/we have read and do understand the foregoing agreement, liability release and assumption of risk agreement, I/we understand that by signing this document I/we are giving up rights to sue today and in the future. I/We attest that all facts are true and accurate. I/We are signing this while of sound mind and not suffering from shock, or under the influence of alcohol, drugs, or intoxicants.
I Agree and declare under penalty of perjury that the foregoing is true and correct.
There is a $50 non-refundable registration fee per student.
There is a full refund (minus $50 registration fee) if cancellation is within 3 weeks of start of the program.
There is a 50% refund (minus the $50 reg. fee) if cancellation is within 2 weeks of registered program.
There is no refund for cancellations within one week of the program.
Additionally, there is a $20 non-refundable transportation fee per student if registered for transportation.
How did you hear about Mount Madonna School Summer Program?
We are a current MMS family
SantaCruzParent.com
Growing Up in SC
Mount Madonna Center
Friend or Family
Google/Web Search
Social Media
Other
What grade level will your child be entering for the 2026-27 academic year?
Preschool
TK
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Would you like someone from our Admissions Team to contact you?
Yes please
No, thank you
Please specify:
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