2022 Cold Spring Summer Camp Registration

2022 Summer Camp Registration Form

Cold Spring Farm PA, LLC258 Spring Valley Road, Oxford PA, 19363
Check Desired Sessions

Session 7: July 25 - July 29Session 9: August 15 - August 19
PLEASE NOTE: Registration is not confirmed until deposit is received

REMINDER - ABSOLUTELY NO CHANGING OF DATES ONCE REGISTERED/NO REFUNDS
EQUIPMENT REQUIRED

All children must bring a horse riding helmet and appropriate riding shoes/boots. Long pants are recommended.

These items can be purchased at Oxford Feed and Lumber, Dover Saddlery or Fair Hill Saddlery or Amazon.
Camper Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Height*
Weight*
Shirt Size*
Allergies or Medical Issues
Riding Experience*

Pre-Riding (never been on a horse and/or may need support to sit balanced in a saddle)Beginner (ridden a horse less than 5 times, little to no experience)Intermediate (taken more than 5 horseback riding lessons and performs basic riding skills)Advanced (takes/has taken horseback riding lessons consistently, can walk/trot and perform basic riding skills, confident and comfortable when riding/working with horses)
Please describe any riding experience or anything we should know about your camper's experience with horses:
Please note, all horses and ponies are assigned by the Camp’s Staff at their discretion. We take into consideration the age/weight/height/experience of campers to ensure a safe and enjoyable time at camp.
Photo Consent and Release*

Yes. Feel free to put my child’s picture on your website, social media, printed materials or other advertising.No. Please do not take or post pictures of my child.
Parent/Guardian Information

including emergency contacts and authorized drop off & pick up
Name*

First NameLast Name
Address*
City*
State*
Zip*
Cell Phone*

Area CodePhone Number
Home Phone*

Area CodePhone Number
Email*
example@example.com
Persons authorized for drop off/pick up*
include name & phone number

Registration & Payment
Fee is $375 per child per session. $350 per child per session if registering for TWO or more sessions. Early bird discount of $350 per child per session is available if Registration and Payment is made before April 1st.

Before care and after care is available at $10.00 per hour per child.

A non-refundable registration deposit of $100 per child per session is required. Balance is due on or before the first day of your child’s camp session.

Please complete this online registration and mail deposit(s) to:

Cold Spring Farm PA, LLC, 258 Spring Valley Road, Oxford, PA 19363.

Cash, money order, or checks made payable to “Cold Spring Farm PA, LLC.”
RELEASE

The undersigned acknowledges that they are the parents/legal guardians of the
applicant/camper and that in consideration of their child being permitted to participate in COLD SPRING FARMs day camp and other riding activities, being aware of the risk of injury to the child and agree that they will be responsible for and hereby release COLD SPRING FARM, its agents, helpers, employers, volunteers, etc. from any and all liability including negligence by reason of injury to their child, themselves, or their property during the day camp and riding activities, including but not limited to: swimming, water activities, day trips, riding lessons, trail rides, exercise, jumping, caring for horses before and after riding, showing, etc.

By signing below, the undersigned acknowledges that they have assumed the risk of equine activities pursuant to Pennsylvania Law, pursuant to the Equine Activity Immunity Act of December 22, 2005, P.L. 472 No. 93 CL 42.
Camper Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Consent Signature*

Clear
Must be parent or legal guardian if under 18

Medical Emergency Information

In the event of an emergency, please contact:
Emergency Contact 1*

First NameLast Name
Relation*
Phone Number*

Area CodePhone Number
Emergency Contact 2

First NameLast Name
Relation
Phone Number

Area CodePhone Number
Medical Consent

Please sign and date either the "Consent Plan" or "Non-Consent Plan"
CONSENT PLAN

In the event that emergency medical aid/treatment is required due to illness or injury during center activities, or while on the property of the agency, I authorize Cold Springs Farm to:

1. Secure and maintain medical treatment and transportation if needed.
2. Release participant records upon request to the authorized individual or agency
involved in the medical emergency treatment.

This authorization includes x-ray, surgery, hospitalization, medication and any treatment procedure deemed “life-saving” by the physician. This provision will only be invoked if the person(s) above is unable to be reached.
Consent Signature

Clear
Must be parent or legal guardian if under 18
Today's Date

MonthDayYear
Date
NON-CONSENT PLAN

I do not give my consent for emergency medical treatment/aid in the case of illness or injury during center activities or while on the property of the agency. In the event emergency treatment/aid is required, I wish the following procedures to take place:
NON-CONSENT PLAN PROCEDURES:
Consent Signature

Clear
Must be parent or legal guardian if under 18
Today's Date

MonthDayYear
Date

Release and Hold Harmless Agreement

Cold Spring Farm PA, LLC258 Spring Valley Road, Oxford PA, 19363
No student will be accepted for equine assisted activities and/or horsemanship
instruction and no volunteer accepted for service at COLD SPRING FARM until this form has been READ, UNDERSTOOD, COMPLETED AND SIGNED by the parent(s) or guardian(s) of a minor or, if the student or volunteer is of legal age and sound mind, by the student or volunteer. Although participation in the program is under strict supervision and every effort is made to avoid injury or accident, the undersigned acknowledges the inherent risks involved in riding, driving, and working around horses. This includes bodily injury from horseback riding or driving or being in close proximity to horses. Among other risks, both horse and rider can be injured during normal use or in competition and schooling.

In order to provide this valuable service, NO LIABILITY can be accepted by the COLD SPRING FARM or any of the organizations or persons connected with the above named facility.IN CONSIDERATION for the privilege of riding, driving and/or working around horses at the COLD SPRING FARM facility, the undersigned, as self, or as parent(s), or guardian(s) of the named minor, jointly or severally, do hereby agree to release, hold harmless and indemnify COLD SPRING CARM, its officers, directors, trustees, agents, employees, representatives, successors and assigns from all manner of liability, loss, costs, claims, demands and damages of every kind and nature whatsoever, including but not limited to reasonable attorney’s fees, which the undersigned or said minor may now or in the future have against COLD SPRING FARM, its officers, directors, trustees, agents, employees, representatives, successors and assigns, on account of any accident, damage, injury or illness, physical or mental condition, known or unknown, to the undersigned or said minor, or the treatment thereof, arising as a result of, or in any way connected to, acts or incidents occurring at or relating to COLD SPRING FARM, its officers, directors trustees, agents, employees, representatives, successors or assigns, including but not limited to their negligence or gross negligence in rendering the
services described above or in any way incidental thereto.

By signing this Release and Hold Harmless Agreement, the undersigned acknowledges that they have assumed the risk of equine activities pursuant to Pennsylvania Law, pursuant to the Equine Activity Immunity Act of December 22, 2005, P.L. 472 No. 93 CL 42.

I have carefully read this agreement and fully understand its contents.
Camper Name*

First NameLast Name
Consent Signature*

Clear
Must be parent or legal guardian if under 18
Today's Date*

MonthDayYear
Date

Payment Information

$100 Deposit Per Camper Due ASAP - Registration is not confirmed until deposit is received
After submitting this registration form, please send the deposit as soon as possible. You can pay multiple deposits with one check. In memo, please put the camper(s) name. The remaing balance is due anytime before their week of camp.

Mail to: Cold Spring Farm PA, LLC, 258 Spring Valley Road, Oxford, PA 19363. Cash, money order, or checks made payable to “Cold Spring Farm PA, LLC.”

Thank you! You will receive a confirmation email after your form has been received.
Should be Empty:

2022 Summer Camp Registration Form

Camper Information

Parent/Guardian Information

Registration & Payment

Medical Emergency Information

Medical Consent

Release and Hold Harmless Agreement

Payment Information