Camp Registration

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

1181 Luebbering Rd.

Luebbering, MO. 63061


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

parents or guardians must complete.) Please complete all blanks.

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 2019

May 29-31:  3 Day Camp  ($180.00)     Over

June 3-7:  5 Day Camp ($300.00)    Over

June 10-14:  5  Day Camp ($300 .00)    Over

June 20-21: 2 Day Camp ($120.00) 1/3 Open

June 24-28:  5 Day Camp ($300.00)    2/5 Open

July 1-2: 2-day Camp ($120) FULL

July 8-12:  5 Day Camp ($300.00)   FULL

July 16-18:  3 Day Camp ($180.00) 1/4 Open

July 22-26  5 Day Camp ($300.00) 5/5 Open

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.  If it is necessary to do a make-up day in a 5 day camp, the show will be moved to the Saturday of that week.  Ultimately participants are responsible  for their attendance and no refunds will be made for absences.

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_____________________


2 Responses to “Camp Registration”

  1. EmmaT says:

    Hi this is Nick Traxler. We spoke before and I do not think you got our registration paperwork for Emma for July 21-23. i mailed this form off today (July 7th) with a check for $180 for Emma to participate. I apologize for the delay. I underwent hip surgery and things have been rather screwy around here since. Please contact me at 314-662-6514 if there are any other problems or concerns.

    Thanks again for your understanding

    Nick Traxler

  2. admin says:

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

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