Vintage Oaks Farm, Camp Registration Form

Vintage Oaks Farm

1749B W. Jarrettsville Rd Jarrettsville, MD 21084 VintageOaksHorseFarm@gmail.com
2024 Camp Registration Form
CAMP DATES
Please check off which camp your child will attend

Horsemanship Pony Camp JUNE 17-21 9am-3:30pm $600Horsemanship Pony Camp JULY 15-19 9am-3:30pm $600
Child's Name

First NameLast Name
Child's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date of Birth
Height
Weight
Parents Name

First NameLast Name
Home Number
Please enter a valid phone number.
Cell Number (if different from home number)
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Email
example@example.com
Is anyone else going to be dropping off or picking up your child?

YesNo
If so, please list name:

First NameLast Name
Before or After Care
Before & After care is available for 1 hour before & after the end of the camp day. See the topof first page for camp hours. Arrangements must be made ahead of time. After Care is $25 per hour.
Will you need Before or After Care?

YesNo
If so, what days?

MondayTuesdayWednesdayThursdayFriday
**Please call the week prior to the start of camp to confirm times for pick up if you need Before or After Care**
Emergency Contact Info
Emergency Contact

First NameLast Name
Emergency Contact
Please enter a valid phone number.
Doctor's Name

First NameLast Name
Doctor's Phone Number
Please enter a valid phone number.
Health Information
Does your child have any known allergies?

YesNo
If so, please list:
Please list all current medications:
Any other important medical information?
Date of last tetanus immunization?
Child’s Riding Experience
Has the child ridden before?

YesNo
If so, please list experience?
Have they attending horseback riding camp before?

YesNo
How did you hear about Vintage Oaks Farm?
Vintage Oaks Horse Show We will be hosting an in house horse show the weekend of JULY 20th & 21st . If you think your child would be interested in participating, please let us know. This will be an additional charge. Interested in more info?

YesNo
Waiver/Rules: I understand that no refunds will be given unless written notice is given prior to 30 days before camp. My child has no physical impairment that would prevent him/her from participating in the camp. I authorize Vintage Oaks Farm, LLC and their counselors to act for my child and me in any emergency requiring medical attention. I agree to indemnify and hold harmless Vintage Oaks Farm, LLC and owners, directors, officers, representatives, employees, counselors, agents, and assigns, from and against any and all claims or liabilities to me or anyone else for any injuries or illness whatsoever including, without limitations to, injuries to my child, and/or property, arising out of or incident to their participating in the Vintage Oaks Farm Summer Camp. You assume the risk of equine activities pursuant to Maryland Law.
- To hold your child’s spot, the Registration Form must be completely filled out & signed
- by a Parent or Guardian. Deposit of $100 must be paid.
- Full amount, minus $100 deposit, is due 30 days before the start of camper’s session. Spaces are limited, please get you Registration & Deposit returned early to hold your child’s spot!
- Make check Payable to Vintage Oaks Farm or VENMO @Kelle-Lerch Mail or drop off to 1749-B W. Jarrettsville Rd, Jarrettsville MD 21084
Signature

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Date

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Date
Should be Empty:

Vintage Oaks Farm

2024 Camp Registration Form

CAMP DATES

Before or After Care

Emergency Contact Info

Health Information

Child’s Riding Experience