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 2023

May 31-June 1:  2 Day Camp ($140.00)    FULL

June 6-8: 3 Day Camp ($210.o0)  FULL

June 13-14:  2 Day Camp ($140.00)  FULL

June 19-23:  5 Day  Camp ($350 .00)    2/5 open

June 28-29:  2 Day Camp ($140.00)  FULL

July 6-7:  2 Day Camp ($140.00)  FULL

July 11-13:  3 Day Camp ($210.00)  FULL

July 18-19:  2 Day Camp ($140.00) FULL

 July 24-28: 5-day Camp ($350)  FULL

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 or Sunday 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_____________________

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