2017 PONY CLUB RESERVATION FORM Kensington Stables Inc. 51 Caton Place, Brooklyn, NY 11218 Tel: (718) 972-4588 www.kensingtonstables.com RIDER INFORMATIONName* First Last Age*Please enter a value between 6 and 11.Date of Birth* Approximate Height*Approximate Weight*We have horses that can accommodate kids up to 240 lbs.Please enter a value between 1 and 240.AllergiesSibling First Last AgePlease enter a value between 6 and 11.Date of Birth Approximate HeightApproximate WeightWe have horses that can accommodate kids up to 240 lbs.AllergiesAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Parent's Email* Home Phone*Work Phone*Cell Phone*Other information you'd like us to know about your child/children:Child/children's previous riding experience:EMERGENCY CONTACTName* First Last Relationship to Child*Daytime Phone*Cell Phone*Winter and Spring Programs Winter Break Week: Feb 20-24 (10:30am-2:30pm) Regular $325 for week or $65 per day. Spring Break Week: April 10-14 (10am-4pm) Registration by March 15 is $425. Regular rate is $450.Check the week(s) you would like your child/children to participate Winter Break Week Spring Break Week Summer Program (10am-4pm) Weeks 1 and 3-10 rates: Registration by March 15 is $425. Regular rate is $450. Week 2 rate (holiday): Registration by March 15 is $360. Regular rate is $380. Inquire about sibling discounts. One day rate is $95/day. Check the week(s) you would like your child/children to participate Summer Week 1: June 26-30 Summer Week 2 (holiday): July 3, 5-8* Summer Week 3: July 10-14 Summer Week 4: July 17-21 Summer Week 5: July 24-28 Summer Week 6: July 31-Aug 4 Summer Week 7: Aug 7-11 Summer Week 8: Aug 14-18 Summer Week 9: Aug 21-25 Summer Week 10: Aug 28-Sep 1 Do you need early drop-off and/or late pick-up?Early drop-off (8:30-10am) and late pick-up (4-5:30pm) are available for $15/hr per day. Early drop-off Late pick-up Would you like to purchase a helmet?Small: 6 1/2- 6 3/4Medium: 6 7/8- 7 1/8Large: 7 1/4- 7/2Ordering takes four weeks, please reserve well in advance.What color helmet would you like?Standard colors are $30, Fashion colors are $35. Standard $30: Blue Standard $30: Green Standard $30: Black Standard $30: White Standard $30: Gold Standard $30: Silver Standard $30: Purple Fashion $35: Blue Mist Fashion $35: Sunset Pink Fashion $35: Lavender Fashion $35: Bronze Fashion $35: Citron Payment InformationTotal DueAdd up the subtotals for Pony Club week(s), drop-off/pick-up hours and helmet and put the total in the box below.Payment MethodWe accept payment by credit card and personal check. If you want to pay by credit card: Check the box "Call me so I can pay with a credit card" and we'll call you to get your credit card information over the phone. If you want to pay with a personal check: Choose "I will send a check." Print the receipt you get via email after you complete this form. Write your check to "Kensington Stables." Mail the printed copy of your receipt and your check to Kensington Stables, 51 Caton Place, Brooklyn, NY 11218. Call me so I can pay with a credit cardI will send a check