ONE WEEK HORSE CAMPS

Use this form whether you want to pay for the event using a check, money order or credit card. No specific credit card information will be asked on this form.

FOLLOW THE INSTRUCTIONS AT THE BOTTOM OF THIS FORM TO MAKE PAYMENT.

PLEASE NOTE: YOU MAY USE ONE FORM TO REGISTER 2 "CAMPERS" AS LONG AS THEY BOTH LIVE AT THE SAME ADDRESS AND HAVE SAME PARENT-GUARDIAN INFORMATION. IF NOT, SEPARATE REGISTRATIONS MUST BE COMPLETED.

ALL REGISTRATIONS REQUIRE A DOWN PAYMENT WHICH MUST BE PAID AT THE TIME OF THE REGISTRATION. RESERVATIONS WILL NOT BE GUARANTEED UNTIL PAYMENT IS RECEIVED.
If you have problems call us at 480-471-8253------Thank You.

* Date of Registration

* Select Horse Camp Dates

* Camper 1 Name

* Date of Birth

* Gender

Male

Female

* Camper1 t-shirt size

* CAMPER 1's Street Name and Number, Suite, PO Box

* City

* State

Zip

* Briefly describe "CAMPER 1'"s experience with horses

* Payment Type

Scholorship Amount

Scholarship Confirmation Number

CAMPER 2 (Applicant's) Name

Date of Birth

Gender

Male

Female

Camper 2t Shirt size

CAMPER 2's Street Name and Number, Suite, PO Box

City

State

Zip

* Select Horse Camp Dates

Briefly describe "CAMPER 2's" experience with horses

* Payment Type

Scholarship Amount

Scholarship Confirmation Number

* CAMPER 1 & CAMPER 2's Parent or Guardian(s)

* Home Phone

* Cell Phone

* Work Phone

* Parent/Legal Guardian mailing address

* City

* State

* Zip

* Primary email address

* Alternate email address

Your registration will NOT be complete until you make payment. You have two options:

Option 1: PAYMENT USING CHECK OR MONEY ORDER. Print out this form; click submit button to send the registration electronically, then mail this application, along with payment to: Agape Youth Ranch, PO Box 11415 Phoenix, AZ 85061-1415.

Option 2: PAYMENT USING A MAJOR CREDIT CARD. Print out this form for your records then hit the SUBMIT. RETURN to www.agapeyouth.org/payment.asp to make payment using a credit card.

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