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REGISTRATION & FORMS
Volunteer Application
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Riding School Registration
Parental Authorization and Release Form
APPLICATION
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Indicates required field
Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Date Of Birth
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Age
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How many in Family?
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Race: White, Black, Hispanic, Other
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Lives with parents, grandparents, other?
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What is the current family structure (i.e. kinship, foster, biological?
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Where does child attend school?
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What grade is your child in?
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Gender
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Male
Female
Home Phone Number
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Other Emergency Number
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Mom's Cellphone Number
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Dad's Cellphone Number
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Best Email
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Mom's Work Number
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Dad's Work Number
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Fees
REGISTRATION FEE: There is a $50.00 non-refundable Registration Fee ($75 for multiple children) to reserve their spot. This fee is an administrative fee and is a one time fee. No part of this fee is applied to your program fees.
$35.00 Per Day 9:00 am - 3:00 pm
$ 4.00
Early Arrival Per DAY (7am-8:30am)
$ 4.00 Extended Stay Per DAY (3:30pm-6pm)
Early drop-off and late pickup are available upon request.
Limited scholarships available to support every child's growth.
Please call 972-932-5156 to apply.
Please understand that you are responsible for payment when you reserve your child's/children's spot for the program. Please ensure you are fully committed. Space is limited, and cancellations may prevent another child from benefiting from our program.
Initial to approve the right to charge for early arrival and extended stay
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Parents Initial
Initial to acknowledge that payment is due in full on the first day of week
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Parents Initial
By initialing, you acknowledge that you have read and agree to this policy.
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What days of the week will your child be attending?
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Methods Of Payment
We accept cash, check, Venmo (Caseys-Place-25), or Zelle (2142648637) .
"There is a $40.00 fee plus amount of check for returned checks!!"
We will be closed for the following holidays:
Memorial Day
July 4th Independence Day
Additional Information and/or Comments
What are your child's strengths, talents, or interests that can be fostered?
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Does your child have an active Individual Education Program (IEP or 504 Plan)
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Does your child require a life jacket?
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Medical Conditions: (check all that apply: __ADHD__ADD __Autism __Other
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Do you consider your child a BEGINNER, INTERMEDIATE, OR ADVANCED swimmer?
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What are your child's specific triggers for anger, fear, or anxiety?
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Does your child have any sensory, mobility or dietary needs?
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Are there any physical or mental impairments that require specialized support or accomodations?
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List ALL Medications taking:
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Allergies to Medications
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Allergies to Foods:
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Allergies to Laundry Detergents/Fabric Softeners/Chemicals/other:
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Doctors Name
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Doctors Phone Number
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Medical Insurance
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Policy Number
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Does your child attend Church, if yes, where?
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How did you hear about us?
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I Hereby do give/do not give permission for the following for my child
Apply / Give Benadryl as needed
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Yes
No
Apply Sunscreen as needed
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Yes
No
Authorize to treat an emergency and/or perform CPR
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Yes
No
Any other notes or concerns that we should be aware of such as mental health issues, special needs, or certain triggers or any fears like water, dogs, etc. PLEASE BE SPECIFIC!!
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Give Motrin as needed
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Give Tylenol as needed
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I Hereby authorize my child to be picked up ONLY by the following persons. In case of an emergency and I can not be reached, I authorize Casey's Place to contact
Name
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Phone Number
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Relationship
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In Case Of
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Pick-Up
Emergency
Name
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Relationship
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Phone Number
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In Case Of
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Pick-Up
Emergency
Name
*
Relationship
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Phone Number
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In Case Of
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Pick-Up
Emergency
Required Supplies for Summer
Requirements: Make sure your childs name is on ALL items
DRESS CODE:
SHORTS (NO SHORT SHORTS)
T-SHIRTS OR MODEST SUMMER TOP
(NO SHOWING BELLY, NO SPAGHETTI STRAPS)
TENNIS SHOES (NO CROCS OR SANDALS)
Closed toed shoes are to be worn at all times on the Farm unless swimming.
NO EXCEPTIONS: If your child shows up without appropriate shoes & clothing, they will set out until you or someone else can bring appropriate items.
Swimming Attire/Bathing Suit (Girls: No bikinis. Girls must wear shorts over their bathing suit. Boys: Shirts required)
Sunblock, Beach Towel, water shoes or flip flops
Goggles if prefer to wear them
Extra Set of Clothes
Meals & Snacks:
A weekly menu will be available. If there is something on the menu that your child/ren does not or will not eat, please send a lunch and or snacks.
If you have any further questions or concerns, please feel free to contact us at 972-932-5156 or by email
[email protected]
Our goal is to create a safe, positive environment for all participants. We reserve the right to decline applications, refuse service, or dismiss participants if their behavior, safety concerns, or program fit do not align with our standards.
Submitter Signature
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Submit
Don't forget to submit the Parental Authorization and release form!
