LUCKY DRIVE RANCH
540-788-9959
Online Registration Available With Payment
By Check or Check By Phone.
Click here To Register Online
OR COMPLETE AND MAIL THIS FORM
RESIDENT RANCH VISIT REGISTRATION
Lucky Drive Ranch
Name: ____________________________
Age: _______ Gender:____________
FOR THE WEEK(S) OF (Please Check Week(s)):
As
availability May change prior to update of page please check with Ranch before
registering. Updated
o
o Early Arrival
Needed For Week(s) Of _________
o Late Pick Up
Needed For Week(s) Of__________
MY CHILD IS A: o
PREVIOUS VISITOR FROM (YEAR) __________ o
LDR STUDENT o NEW VISITOR
PARENT'S’/LEGAL GUARDIANS' NAME:
_________________________________________________
ADDRESS:
__________________________________________________
(RR, STREET NUMBER)
__________________________________________________
(CITY) (STATE) (ZIP)
TELEPHONE: (H) _________________________
(W) ______________________
(OTHER) ____________________
(H)EMAIL: ________________(W) EMAIL:
___________________
VISIT FEES ENCLOSED
TOTAL DUE CAMP FEES DUE $____________ TOTAL EARLY ARRIVAL FEES
DUE $_____________
TOTAL LATE PICK FEES DUE $___________________ TOTAL DUE $__________________
By signing below I attest that I am the legally responsible parent and/or legal
guardian of the child that I am enrolling.
I understand and agree that if I withdraw my child before
___________________________________________ _____________
Signature of Parent or Guardian Date
Please
Note: The parent or legal guardian of
visitor must be present on first day of visit or arrangements for completion of
necessary information and signed waivers must be made
in advance.