Camp Registration

Prairie School Road Farm LLC  For registration to be complete, the liability form must also be


1181 Luebbering Rd.

Luebbering, MO. 63061


Horsemanship Day Camp Registration Form(For participants younger than 21,

parents or guardians must complete.)

Name_______________________________ DOB ________Address_________________________________City______________State____Zip____

Home Phone Number___________________ E-mail ____________________Emergency Contact______________________Phone_________

Favorite Color_________________ t-shirt size_______________ OK to put your child’s picture on facebook?   ______________.

Medical Conditionsand/or allergies________________________________________________________________________­­­­­­­­­­­­­­


Please indicate if ever stung by an insect and describe any reaction that occurred. _____________________________________________________________________________________________________________________________________

_______________________________________________________________________________Insurance Provider and ID number________________

Call to schedule a visit to check us out.  636-629-1476

Summer Schedule 2018

May30-June 1:  3 Day Camp  ($180.00)     4 Openings

June 4-8:  5 Day Camp ($300.00)    FULL

June 11-15:  5  Day Camp ($300 .00)       FULL

June 18-22: 5 Day Camp ($300.00)   One Opening

June 25-June 29:  5 Day Camp ($300.00)    FULL

July 2-3: 2-Day Camp ($120.00)  3 Openings

July 5-6:  2 Day Camp ($120.00)   3 Openings

July 9-13:  5 Day Camp ($300.00)   5 Openings

July 17-19:  3 Day Camp ($300.00) 4 Openings

Camp Clinics, Special group and family camps may be arranged on request.  Changes in the schedule may occur depending on enrollment requests.

Deposit of  half of the camp fee is required at time of registration and the balance is due one week before the registered session. The deposit is Nonrefundable.  Late fee after June 1 of $25.00.  Refunds are only  made if PSR Farm must cancel.  If camp dates are changed due to weather every attempt to accommodate campers will be made to schedule make-ups.  Ultimately participants are responsible  for their attendance and no refunds will be made for these situations.

If participant is a minor, permission must be provided for the instructors of Prairie School Road Farm LLC Horsemanship Day Camp to obtain medical treatment for the participant(s) should it become necessary.

Prairie School Road Farm LLC Day Camp Instructors have permission to obtain medical treatment for _________________________ if the necessity should arise.

Signed ______________________________________  Date_____________________


One Response to “Camp Registration”

  1. admin says:

    Not a problem. We will be looking for your information. Thanks.

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