Summer Camps in Harrisburg, Pa

If you have mutiple children to sign up for camp, please fill out an application and deposit for EACH child.

Please provide the following information for the child attending this camp.

Camper's First Name *

Camper's Last Name *

Camper's Birth Date *

Camper's Age *

Camper's Street Address *

City

State

Country

Postal code

Please provide the following information for the main point of contact.

Parent/Guardian 1 Full Name *

Parent/Guardian 1 Relation to Camper

Parent/Guardian 1 Phone *

Parent/Guardian 1 Email *

If you wish to provide contact information for an additional parent/guardian, please do so below.

Parent/Guardian 2 Full Name

Parent/Guardian 2 Relation to Camper

Parent/Guardian 2 Phone

Parent/Guardian 2 Email

In the event of an emergency, please provide a contact that may be called if the parent/guardians listed above can not be reached.

Additional Emergency Contact Relation to Camper

Additional Emergency Contact if different than Parent/Guardian

Additional Emergency Contact Phone

If your child has any health concerns we should be aware of, please describe below:

Ex; allergies, asthma, etc.

Please list below the full name of anyone you may permit staff to release Camper to if different than Parent/Guardians listed above:

Alternate Pick Up 1

Alternate Pick Up 2

Terms & Conditions *

I understand that no fees will be refunded for missed days or illnesses during scheduled camp dates with the exception of change made by MAPLE VALLEY ACRES due to severe weather/unforeseen circumstances. $50 is due upon camp registration for the weeks registered and is non refundable.

I hereby give permission for my child to be photographed during Maple Valley Acres Horse/Pony Camp. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Maple Valley Acres.

By participating in Maple Valley Acre’s Summer Camp, I acknowledge and accept the inherent risks associated with equine activities. I agree to release and hold harmless the organizers, staff, and volunteers from liability for injuries or damages that may occur during the activity. Participants under the age of 18 must have a parent or guardian sign this waiver. Please follow all safety instructions provided by staff for a safe and enjoyable experience.

I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of the additional emergency contacts I've listed above. In case of a life threatening emergency, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician).

I agree to all terms & conditions provided above by Maple Valley Acres. By providing my phone number and email address, I agree to receive occasional text messages and emails from the business.

Parent/ Guardian Signature

Clear

Sell Products *

Equine Science Camp Deposit

June 24-26, 2025

Campers Age 10-16

You are paying the required non-refundable deposit of $50 to secure a spot, an invoice of the remaining balance of $250 will be sent to the email provided 2 weeks prior to the selected camp dates. Invoice balance must be paid in full before attending camp.

$50