Welcome to Renegade Farm::Summer Camp Registration

Apache Tier Horse Camp 2008 Enrollment Form

Please Make Checks Payable to * :
Apache Tier Horse Camp

Application is below, please complete, print, sign and mail (or fax) with Non-Refundable Deposit to:

Renegade Farm
5489 Mariaville Rd
Schenectady NY 12306
Lynn@renegadefarm.com
Phone: (518) 864-5518
Fax: 518-864-5821

Enrollment:

5 Day Camp - $300.00 per session
Lunch from Mariaville Lakeside Store - $35.00 (Five Day Camps only)
3 Day Camp - $170.00 per session

$50.00 non-refundable deposit is required by April 1, 2008 for the 3-day sessions and a $100 non-refundable deposit is required by April 1, 2008 for the 5-day sessions. Balance due in full by July 1, 2008. A $25.00 fee will be assessed for each returned check.

$10.00 discount per student when 2 or more students from same family enroll and/or 5 % discount given if full payment is received by May 1, 2008. Discounts do not pertain to lunch fee.

Upon receipt of the non-refundable deposit per student, an invoice & liability release form will be sent approximately 30 days from start of camp. The liability release form must be signed and returned prior to the start of camp or the child will be unable to participate in the horseback riding activities.

Make checks payable to
Apache Tier Horse Camp
mail to 5489 Mariaville Rd.
Schenectady, NY 12306
No camp fee will be refunded after 7/1/08

For jump camp, rider must have ridden consistently for past 3 years & be able to ride without stirrups at a trot & canter and be at least 11 years of age

Please check all weeks attending camp (indicate your preference with 1, 2, 3, etc. with 1 being your first preference): Each week is limited to 6 students! Minimum age for 5-day camps is 8yrs;for 3-day camps is 6yr.

Week	Openings Left	Number of Days	Time	Date	Lunch	Attend this Session
1	4	3 Days	8:30 - 12:30 Tues, Wed, Thur	07/01 - 07/03	No Lunch Available
2	4	5 Days	8:30 - 1:30	07/07 - 07/11	Add Lunch
3	6	3 Days	8:30 - 12:30 Tues, Wed, Thur	07/15 - 07/17	No Lunch Available
4	5	5 Days	8:30 - 1:30	07/28 - 08/01	Add Lunch
5	6	3 Days	8:30 - 12:30 Tues, Wed, Thur	08/05 - 08/07	No Lunch Available
6	4	5 Days	8:30 - 1:30	08/18 - 08/22	Add Lunch
7	6	5 Days	8:30-1:30 Beginning jump camp	08/25 - 08/29	Add Lunch

Personal Information
Horse Enthusiast Name:
Gender:	Male: Female:
Date of Birth:
Age:
Grade (As of Sept. 08)
Height:	ft in
Weight:	lbs
Address 1:
Address 2:
City, State, Zip Code:	,
Home Phone Number:	- -
Cell Phone Number:	- -
E-Mail Address:
Mother's Name:
Day Time Phone Number:	- -
Father's Name:
Day Time Phone Number:	- -
Who has Custody of the Child:	Both Parents Mother Father
Who Will Pick Up the Child:
Emergency Contact:
Relationship to Child:
Emergency Phone Number:	- -
Riding Preference:	Western English No Preference
In Last Two Years, Camper has Ridden:	Less than 10 hrs 10 - 20 hrs 20 + hours, consistently
Where Has Camper Previously Ridden:

Horse Enthusiast Attire

All students are required to wear ankle length pants. Riding boots and approved riding helmets will be supplied.

Invoice and Release of Liability

Parental Agreement

My child may attend Apache Tier Horse Camp and I hereby certify that he/she is capable of participating in the horse activities. I understand the camp does not carry health and accident insurance and that I am responsible for health incurred costs.

I also grant Apache Tier Horse Camp and its agents full authority to take whatever actions they deem necessary regarding my child’s health and safety, and I fully release the Princetown Horse Farm LLC d.b.a. Renegade Farm/Apache Tier Horse Camp from any liability in connection with those decisions. I understand my child must comply with camp rules and standards of participant behavior. I agree that Apache Tier Horse Camp has the right to enforce appropriate standards of conduct and may dismiss, without a refund, any camper who infringes on the rights of others.

Further, I give my consent for the use of any photographs, slides or video tapes, which may include my child to be used in the Princetown Horse Farm LLC d.b.a. Renegade Farm/Apache Tier Horse Camp promotional materials.

Parent Authorization for Treatment

In the event I can not be contacted in an emergency, I hereby give permission to the physician selected by the camp director to hospitalize and to secure treatment for my child.

Medical History
Family or camper's medical insurance company
Policy Number
Insured's (Policy Holder) Name
Insured's (Policy Holder) Employer
Please make us aware of any special or medical problems that your child has in order to ensure their safety. Are there any special or medical problems of which we should be aware?	Yes No
If yes to the previous question, please describe below. Please not this information will be kept confidential.

The child named on this enrollment form has my permission to engage in all horse related activities of Apache Tier Horse Camp except as noted on the form by me.

My child may not Participate in the following activities: