Online Registration for Riding lessons & Equestrian Programs

Please complete the required information below.  If you do not enter any of the required fields, you must use the BACK button in your web browser to return to this page and fill in the additional information.  (Not using this feature will result in a deletion of all previously entered data.)

Please make note of the following registration policies:

  • Online registrations are subject to space availability and cannot be processed without accompanying credit card information authorizing payment of either the required minimum non-refundable deposit of $35 or payment in full.   You will receive an email confirmation letter with your day and time-slot when it is assigned.
  • PAYMENTS:  Full payment must be received at least 14 days before the start of the session. 
  • CHANGES/CANCELLATIONS: All changes and cancellations must be made in writing.   Send  notice via Email to register@campberachah.org  -  Fax to 253.833.7027  -  or by US MAIL to 19830 SE 328th PL Auburn, WA  98092.  Any approved refund amounts will be issued within 30 days of cancellation notice. 
  • RELEASE FORMS:  Required release forms will be emailed with your confirmation letter.

Rider Information:

    
(* indicates required fields)    
secured site    
  Riders Last Name:*
First:*
 MI:
  Birthday (MM/DD/YY)*
Gender:*
 
  Age:*
Height:*
 Weight:*
 CHA Riding Level:
  
 

We reserve the right to deny a student a lesson space if we determine that student does not meet the height and weight standards for safety of the student and/or horse. (Minimum height for a student is 53" for Western & English Sessions).

  
  Street Address:*
  City:*
 State:*
 
  Zip code:*
   
  Parent1/Guardian Last Name:*
 First:*
  
  Home phone:*
Work phone:*
Cell/Pager phone
 
  Email:* (required for confirmation)
  
 

(Please enter your email address above for confirmation that we received your registration request. If you would like to opt out of future email notifications of news and events, you may do so by marking the box below.)

If you do NOT want to receive e-mail notification of future Camp Berachah events & activities please enter your initials here: 

 

I give permission for Camp Berachah to use any photo or video of my family in publications.

I release my right to any kind of remuneration for said photos." 
If you agree please type your initials here:*

  How did you hear about us?

Select Desired Lesson(s):

  

Please note: New students must be at least 53" tall.

 

  
(Multiple Selections allowed, hold CTRL while selecting)
 

Indicate two Day and Time Preferences:

Western Lesson Times:

Level 1: Monday, Wednesday, Thursday at 3 pm or 4:30pm, Saturday at 10am, 11am or 1pm

Level 2: Wednesday, Thursday at 6pm or 7pm, Saturday at 2pm

Levels 3&4: Monday 6 pm

 

Recreational Vaulting Lessons:

Instruction on vaulting barrel and mounted instruction - 12 lessons Saturday 3-5pm

 

English Lesson Times:

Level 1: Monday 6pm

Level 2: Monday 7pm, Tuesday at 3pm, Friday at 3pm or 4:30pm

Levels 3 and 4: Dressage and Jumping Wed or Thurs 6 pm

 

Therapeutic Lesson Times:

Summer: Tuesday, Wednesday, Thursday or Friday at 9:00am, 10:00am or 11:00am

Fall, Winter & Spring: Monday, Tuesday, Wednesday or Thursday at 1:00pm, 2:30pm or 4:00pm
1st Choice: Day: Time:

2nd Choice Day: Time:

 

Current Medical Conditions:
 

Additional Registration Notes or Comments:
     

After submitting this registration information,
you must make a payment to complete the process.

If you did not enter any of the required fields, you must come BACK and complete.
Copyright © 2008 Camp Berachah Ministries
designed by ir2media