Saddle Up Harrisburg · Equestrian Summer Day Camp

Camp Information

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

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

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

Special Needs, Accommodations & Program Questions

Saddle Up Harrisburg is committed to an inclusive experience for all campers. Please share anything that helps us best support your child.

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

No

If yes — please describe in full detail

Does the camper have an active IEP or 504 Plan?

Yes No

If yes — describe relevant accommodations

Behavioral / Social Notes (optional)

Equestrian Experience

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

Yes No

If yes — describe experience & skill level

Program Questions

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

Applying for Financial Assistance?

Parent / Guardian Willing to Volunteer?

Additional Comments (optional)

Agreements & Parent/Guardian Signature

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

Liability Waiver & Release

I understand that participation in equestrian activities involves inherent risks including falls, kicks, bites, and unpredictable animal behavior. I voluntarily consent to my child's participation and release Project Cultivate, Inc., Saddle Up Harrisburg, staff, volunteers, and partners from any claims or liability arising from participation, except in cases of gross negligence.

I have read and agree to the Liability Waiver & Release *

Photo & Media Release

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

I have read and agree to the Photo & Media Release *

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. Disruptive or unsafe behavior may result in removal from the program without refund. I commit to ensuring my child arrives on time, properly dressed, and prepared daily.

I have read and agree to the Camp Rules & Code of Conduct *

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 confirm all medical information provided in this application is accurate and complete. All medical costs are the responsibility of the parent/guardian.

I have read and agree to the Medical Emergency Authorization *

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.

After submitting you will see a personalized confirmation. Questions? Email info@project-cultivate.com