FANCY FOX FARM, LLC

Riding Camp Application For Enrollment

 

 

Please complete this application and mail it with your $250.00 deposit and

signed Equine Activity Release/Waiver to: 

 

Fancy Fox Farm, LLC

10359 Crestwood Lane

Rixeyville VA, 22737

 

If you have questions, call us at 540-937-6121

Complete a separate application & Equine Activity Waiver  for each child you wish to enroll.

 

Camper’s Name:___________________________    Nickname:_________________M or F?___

Camper’s Address:______________________________________________________________

_____________________________________________________________________________

Mother’s Name:_________________________________    

Mother’s Address (If different from camper):_________________________________________

_____________________________________________________________________________

Father’s Name:__________________________________    

Father’s Address (If different from camper):__________________________________________

______________________________________________________________________________

Camper lives with:                                                        _____Father   _____Mother   _____Both                                                      

Include Area Codes	Mother/Female Guardian	Father/Male Guardian
Home Phone:
Work Phone:
Cell Phone:

Doctor’s Name:___________________________________Phone Number:_________________

Insurance Name:__________________________________Policy Number:_________________

Please indicate any medical conditions:______________________________________________

______________________________________________________________________________

______________________________________________________________________________

 

We must know if your child is allergic to anything: food, plant, insect, animal, etc.

Allergen(s)_____________________________________________________________________

Symptoms:_____________________________________________________________________

______________________________________________________________________________

Treatment:___________________________________________________________________________________________________________________________________________________

All medications must be in the original container(s).  All medications will be held and dispensed by the camp director.  Please list medication information below:

TIME	EVENT	MEDICATION, DOSAGE AND OTHER DIRECTIONS
7:00-8:00 AM	Breakfast
12:00-1:00 PM	Lunch
4:30-5:30 PM	Supper
8:00 PM	Bedtime
Other Special Instructions (use additional sheet of paper if needed)

Circle the medicines below that we have your permission to administer in age appropriate doses:

Tylenol                 Ibuprofen                     Calamine Lotion              Cough Syrup

 

Describe camper’s previous riding experience:_________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

How did you hear about Fancy Fox Farm Riding Camp?_________________________________

______________________________________________________________________________

Is there anything you can tell us that might make your camper’s experience more enjoyable?____

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Campers Date of Birth:________________

 

Camper’s Swimming Ability: Circle One

             None                Beginner                       Intermediate                        Advanced                                

 

 

 

Payment Terms And Cancellation Policy

Please make all checks payable to: Fancy Fox Farm, LLC.  Returned checks will be assessed a bad check fee of $35.00.

 

A non-refundable, non-transferable deposit of $250.00 is required to register for camp.  Your check or money order must accompany this application.  The tuition balance is due prior to attending camp.  Cancellations within 10 calendar days prior to the camp start date will result in forfeiture of deposit and tuition if we are unable to fill the vacancy.  In the event that we do not have space for your child to enroll, we will notify you and your deposit will not be processed.

 

Releases and Signatures

I give the staff of Fancy Fox Farm, LLC permission to seek medical attention for my child in the event that I’m unavailable in an emergency or when the extent of the emergency requires immediate medical attention.  Parent’s Initials:______________________________

 

If my child attends camp over the 4^th of July, I authorize Fancy Fox Farm, LCC to transport my child to and from the Public Fireworks Display which will be held in Culpeper VA.  Parent’s Initials:________________________________

 

I understand that Fancy Fox Farm, LLC does not issue refunds if a camper goes home early due to homesickness or unwillingness to follow rules.  Parent’s Initials:_______________________

 

I authorize the Fancy Fox Farm, LLC to have and use photographs and videotapes of the person named on this application as may be needed for its records, publications or public relations program.  Parent’s Initials:________________________________

 

By signing this application, I am indicating that I have read, understood, and will agree to the terms and conditions contained on this Application, the Equine Activity Release/Waiver and the Camp Information Sheet.

 

Signature of Parent:_________________________________                     Date:_____________

 

Please return this application, $250.00 deposit, and signed Equine Activity Release/Waiver

 

 

See Camp Information Sheet Below

Equine Activity Waiver on Separate Web Page

 

 

 

 

 

Camp Information Sheet

(Keep this for your information)

 

Arrival & Departure

Children will arrive around 1:00 PM Sunday and depart Saturday 3:00 PM.  Multiple week stays are encouraged to achieve marked riding progress.

 

Money

No cash is needed at camp, except for those campers attending the 4^th of July fireworks, where there are various venders.

 

IMPORTANT--What Campers Need to Bring!

 

Items Required To Ride:

1)  A properly fitted, ASTM approved riding helmet with chin strap must be worn while riding.  These can be found at your local coop or tack store.

2)  Hard-soled leather shoes with at least 1/4 inch heels must be worn while riding.  This is a safety requirement.  No hiking boots, sneakers, tennis or canvas shoes, etc will be permitted for riding.

 

Essential Items to Stay the Week:

Clothes	Toiletries	Other
ASTM approved helmet	soap/shampoo	Sleeping Bag
Riding appropriate shoes/boots	toothbrush/paste	Pillow
4 - pairs of long pants/blue jeans	Comb/brush	Set of twin sheets
3 - long sleeve shirts	Bug Spray	Warm blanket
Sweat shirt or jacket	Any medications	Flashlight
7 - pairs of underwear	Sun Screen recommend SPF 15 or greater	Hat with brim/cap
7 - pairs of socks	Hair accessories to pull hair back for riding	Water bottle
7 - T-shirts (no tank tops for riding)	3- towels
Swimsuit
Rain gear
Sneakers
sandals/flip flops

 

Optional Equipment                                                                           Other

Camera                                                                                                Be ready with your favorite camp tales and songs!

Foam pad for cot/sleeping bag

Fishing poles                                                                                        We will have a Hawaiian Night,

Horse treats/carrots                                                                              bring anything along that fits the theme!

Ear plugs/pool toys

 

You May Bring Your Own Horse

Campers may bring their own horses to camp on a space available basis.  Please contact us when applying to ensure there is room available. All horses coming to camp must have a Negative Coggins Test, have been shod in the last 3 to 4 weeks before camp, have been wormed within 60 days of camp start, and must not have vices such as kicking, biting, cribbing, etc that could cause unsafe conditions for campers or damage to camp facilities.  We will provide a turnout area for campers’ horses, but campers who bring their own horse will be responsible for care and feeding and must bring feed to sustain their horse.

 

Phones/Cell Phones/Video Games

One of the benefits that children receive from residential summer camp is an increase in independence. We believe that phone calls between parents and children can interfere in this development of self-reliance.  Campers may not use the phones and may not bring cell phones or video games to camp.  We will be pleased to talk to you about your child, but please remember we are actively engaged out-of-doors with the children and although we will be checking for messages periodically, may not be able to return phone calls until lights out.  Of course, true emergency calls will be answered promptly.