Mountain of Fun Summer Program Registration Step 1 of 2 50% Student Legal Name:* First Last Student's Preferred Name(If different than given first name) Age in September 2023*345678910111213Gender* Preferred Pronoun Select a camp and week(s) to attendAvailable camps will appear below based on your child's age selected above.Mountain Explorers (Ages 6-10)July 10-14, 2023 ($395) Sign me up for Mountain Explorers, week of July 10! Not attending this week HiddenJuly 10-14, 2023 (SOLD OUT!!)If you aren't registering your child for another camp, you may fill out the waitlist form here. Add me to the July 10 Mountain Explorers Waitlist Not attending this week HiddenOptions for July 10 Sign me up for Afternoon Horsemanship Lessons: Week of July 10 Afternoon Horsemanship Sold Out for July 10 Add me to the July 10 Afternoon Horsemanship waitlist Add Transportation - July 10-14Transportation is provided on a first-come, first-serve basis at time of registration. Cost is $75 per week, roundtrip. Select your pick-up / drop-off location. No transportation needed Ocean side: Aptos (Aptos Naturals/Library) 8:25am/4:00pm Ocean side: Corralitos (Alladin Nursery/5-mile House) 8:35am/3:50pm Inland side: Morgan Hill (DeWitt&Dunne) 8:15am/4:20pm Inland side: Gilroy (Redwood Retreat) 8:35am/4:00pm July 17-21, 2023 ($395) Sign me up for Mountain Explorers, week of July 17! Not attending this week HiddenJuly 17-22, 2023 (SOLD OUT!!)If you aren't registering your child for another camp, you may fill out the waitlist form here. Add me to the July 17 Mountain Explorers Waitlist Not attending this week HiddenOptions for July 17 Sign me up for Afternoon Horsemanship Lessons: Week of July 17 Afternoon Horsemanship Sold Out for July 17 Add me to the July 17 Afternoon Horsemanship waitlist Add Transportation - July 17-21Transportation is provided on a first-come, first-serve basis at time of registration. Cost is $75 per week, roundtrip. Select your pick-up / drop-off location. No transportation needed Ocean side: Aptos (Aptos Naturals/Library) 8:25am/4:00pm Ocean side: Corralitos (Alladin Nursery/5-mile House) 8:35am/3:50pm Inland side: Morgan Hill (DeWitt&Dunne) 8:15am/4:20pm Inland side: Gilroy (Redwood Retreat) 8:35am/4:00pm July 24-28, 2023 ($395) Sign me up for Mountain Explorers, week of July 24! Not attending this week Add Transportation - July 24-28Transportation is provided on a first-come, first-serve basis at time of registration. Cost is $75 per week, roundtrip. Select your pick-up / drop-off location. No transportation needed Ocean side: Aptos (Aptos Naturals/Library) 8:25am/4:00pm Ocean side: Corralitos (Alladin Nursery/5-mile House) 8:35am/3:50pm Inland side: Morgan Hill (DeWitt&Dunne) 8:15am/4:20pm Inland side: Gilroy (Redwood Retreat) 8:35am/4:00pm Redwood Explorers (Ages 9-13)July 10-14, 2023 ($395) Sign me up for Outdoor Survival Camp- July 10-14! Not attending this week HiddenJuly 10-14, 2023 (SOLD OUT!)If you aren't registering your child for another camp, you may fill out the waitlist form here. Add me to the July 10 Redwood Explorers Waitlist Not attending this week HiddenOptions for July 10 Sign me up for Afternoon Horsemanship Lessons: Week of July 10 Afternoon Horsemanship Lessons Sold Out Week of July 10 Add me to the July 10 Afternoon Horsemanship waitlist Add TransportationTransportation is provided on a first-come, first-serve basis at time of registration. Cost is $75 per week, roundtrip. Select your pick-up / drop-off location. No transportation needed Ocean side: Aptos (Aptos Naturals/Library) 8:25am/4:00pm Ocean side: Corralitos (Alladin Nursery/5-mile House) 8:35am/3:50pm Inland side: Morgan Hill (DeWitt&Dunne) 8:15am/4:20pm Inland side: Gilroy (Redwood Retreat) 8:35am/4:00pm July 17-21, 2023 ($395) Sign me up for Creative Arts Experience - July 17-21! Not attending this week HiddenJuly 17-21, 2023 (SOLD OUT!)If you aren't registering your child for another camp, you may fill out the waitlist form here. Add me to the July 17 Redwood Explorers Waitlist Not attending this week HiddenOptions for July 17 Sign me up for Afternoon Horsemanship Lessons: Week of July 17 Afternoon Horsemanship Sold Out Week of July 17 Add me to the July 17 Afternoon Horsemanship waitlist Add TransportationTransportation is provided on a first-come, first-serve basis at time of registration. Cost is $75 per week, roundtrip. Select your pick-up / drop-off location. No transportation needed Ocean side: Aptos (Aptos Naturals/Library) 8:25am/4:00pm Ocean side: Corralitos (Alladin Nursery/5-mile House) 8:35am/3:50pm Inland side: Morgan Hill (DeWitt&Dunne) 8:15am/4:20pm Inland side: Gilroy (Redwood Retreat) 8:35am/4:00pm Nature Explorers (Ages 3-5)Nature ExplorersNature Explorers WeeksChoose the weeks you would like your child to attend: June 26 - June 30 July 5-7 (holiday week) July 10-14 July 17-21 July 24-28 July 31-August 4 Number of days (June 26-30)* 3 days (Monday/Tuesday/Thursday) 5 days Number of days (July 10-14)* 3 days (Monday/Tuesday/Thursday) 5 days Number of days (July 17-21)* 3 days (Monday/Tuesday/Thursday) 5 days Number of days (July 24-28)* 3 days (Monday/Tuesday/Thursday) 5 days Number of days (July 31-Aug 4)* 3 days (Monday/Tuesday/Thursday) 5 days Add Transportation?Transportation is provided on a first-come, first-serve basis at time of registration. Cost is $75 per week, roundtrip. (The price of transportation is the same for 3 or 5 days) Which weeks would you like transportation? Week 1 (June 26-30) Week 2 (July 5-7) Week 3 (July 10-14) Week 4 (July 17-21) Week 5 (July 24-28) Week 6 (July 31-Aug 4) Select your pick-up / drop-off location.* Ocean side: Aptos (Aptos Naturals/Library) 8:25am/4:00pm Ocean side: Corralitos (Alladin Nursery/5-mile House) 8:35am/3:50pm Inland side: Morgan Hill (DeWitt&Dunne) 8:15am/4:20pm Inland side: Gilroy (Redwood Retreat) 8:35am/4:00pm HiddenWould you be interested in additional weeks of camp?We will let you know if we add on more weeks! Redwood or Mountain Explorers - July 25-29 Full-day Horse Camp - August 8-12 Total $0.00 Please click next to continue on to child, family, emergency, and payment information. Parent/GuardianName:* First Last Relationship*MotherFatherStepmotherStepfatherGuardianPartnerOtherAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Does the child live at this address:* Full time? Part time? Home PhoneCell PhoneWork PhoneEmail* Parent/GuardianName: First Last Relationship:FatherMotherStepmotherStepfatherGuardianPartnerOtherAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Does child live at the address: Full time Part time Home PhoneCell PhoneWork PhoneEmail Emergency ContactsIn addition to parents, to be called in case of emergency (must be 18 years of age or older)Name* First Last Relationship:*AuntBrotherFatherFriendGrandfatherGrandmotherMotherNeighborSisterStepparentUncleOtherPhone*Name First Last Relationship:AuntBrotherFatherFriendGrandfatherGrandmotherMotherNeighborSisterStepparentUncleOtherPhoneMedical InformationFamily Doctor Doctor's PhoneDentist Dentist's PhoneIs your child on any regular medication?* Yes No If YES, please specify:* Allergies/Dietary Restrictions?* Any religious objections or exemptions to medical treatment?* Yes No 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 Acetaminophen Chewable Acetaminophen Ibuprofen 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?Medical Insurance InformationName on Insurance Policy Insurance Carrier ID# of Policy Holder Group # Effective Date Phone # of Carrier Carrier Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PermissionsI 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 Horse Program InformationYou have chosen to enroll your child in a horse camp or program. Please read the Mt. Madonna Stables liability waiver and fill out the following fields. 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 Jurisdication 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. Cancellation Policy: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 $50 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 SC Sentinel The Pajaronian Growing Up in SC Morgan Hill Times Gilroy Dispatch KAZU Radio Mount Madonna Center Friend or Family Google/Web Search Social Media Other Please specify: Promotional Code Total $0.00 Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Billing Email* Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name
