2010 Ramblewood Farm Summer Camp Application

Summer Camps run from 9:00 am on Friday until 4:00 pm on Saturday. 

Camp fees are $200 each session or $375 for two sessions.

Each camp is limited to 12 riders.

Please check the date(s) you would like to attend:

____Session 1 – June 18-19

____Session 2 – August 13-14

Camper’s name: _________________________________________________________

Age:  ________

Parent’s name: ___________________________________________________________

Address: ____________________________________________________________________________________________________________________________________________________________

Medical Information:

Contact in an emergency:____________________________________________________

Phone number: ___________________________________________________________

Allergies: ____________________________________________________________________________________________________________________________________________________________

Medications that would need to be dispensed during camp: ____________________________________________________________________________________________________________________________________________________________

Up to date on tetanus shot? __________

Physician name: __________________________________________________________

Phone number: ___________________________________________________________

Any physical limitations we should be aware of? ____________________________________________________________________________________________________________________________________________________________

We will be swimming during the day, is the camper a proficient swimmer? __________

Special diet?  Any foods that the camper does not like? Favorite foods for breakfast/lunch/dinner? ____________________________________________________________________________________________________________________________________________________________

Anything else the staff should know?  Any overnight needs? ________________________________________________________________________________________________________________________________________________

What would you like to do during camp?  What are activities that you have enjoyed in the past?  Any new ideas?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AUTHORIZATION FOR EMERGENCY TREATMENT OF MINORS

I, (we) hereby agree to assume all responsibility and risk from the use of riding, driving and handling of horses while at Ramblewood Farm.  And I further agree to hold Ramblewood Farm’s teachers, trainers and employees free from all dangers or liability for an injury to person or property arising as a result from the use of, or lessons on, said horses or equipment while staying at Ramblewood Farm.

The undersigned parents or guardians of student or minor herby give consent to an x-ray, examination, anesthetic, medical or surgical diagnosis or treatment and/or hospital service that may be rendered to said minor under the general or specific instructions of any physician or hospital.

It is understood that this consent is given in advance of any specific diagnosis or treatment which may be required, but if given, to encourage the staff of Ramblewood Farm, hospital staff and such physicians to excise their best judgment as the requirements of such diagnosis or treatment.  The undersigned shall pay all fees for doctors, hospitals, ambulances and all other medical charges reasonable or necessarily incurred.

Child’s full name: _________________________________________________

Parent/guardian signature: __________________________________________

Date: _______________________