Willowgait Farm.LLC
135 Land End Road
Knotts Island,
North Carolina
Contact: Carol Molloy
757 718-8993
willowgaitfarm@cox.net
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Willowgait Farm
135 Lands End Road
Knotts Island, NC 27950
CAMP REGISTRATION FORM Camper’s Name: ____________________________________________ Age_____________ (one form per child) Please specify the camp(s) and the dates you are requesting___________________________ Parent/Guardian Name: ________________________________________________________ Address: __________________________________________________Email: ______________ Phone #s Home : _________________ Mobile 1 #: ______________(who)_________________ Add’l Emergency #: ______________________(Name):_________________________________ Allergies____________________________Riding experience_____________________
