Brewer Equestrian Center

What Your Camper Will Need:

Summer Camp

What Your Camper Needs:

*Sunscreen, first application of the day applied before arrival

*Bug Spray

*Change of clothing (this can be shorts and tank style top or bathing suit)

*Hard Toe Shoes/Boots

*Either riding pants or full length leggings, or non flare good fitting jeans/pants.

*T shirt or polo style shirt for riding and working with the horses

*Towel

*Sack Lunch (we do have a fridge and microwave)

*We will provide snacks and water throughout the day to keep hydrated

What Your Camper Could Use:

*Riding Helmet (we do have some for use)

*Rubber Boots

*A plastic tub to put their supplies in. This would be great for them to keep their things organized and easy to find. Just put their name on the lid with a sharpie.

Summer Camp Application

Brewer Equestrian Center
SUMMER CAMP 2009 APPLICATION

Rider’s Name: ______________________________________ M/F
Date of Birth: ___________ Age: ____________
Address: ____________________________________________________

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Mother’s Name: ________________________________________________
Mother’s Address: ______________________________________________
Mother’s home ph: __________________ Work ph: ________________
Mother’s cell: ________________
Father’s Name: _________________________________________________
Father’s Address: _______________________________________________
Father’s home ph: ________________ Work ph: __________________
Father’s cell: _________________
Alternative Emergency Contact Information:
Name Address Phone Numbers
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List any individuals who may pick the child up from camp:
Name Phone Numbers
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Experience:
Has your child ever taken riding lessons? _______________
If so, when: ___________________ Western or English (circle one)
Approximate number of lessons: __________________
How would you describe your child’s riding ability (circle one):
Beginner Advanced beginner Low intermediate
Intermediate Advanced intermediate Advanced
Can your child groom a horse independently? Yes No
Can your child pick a horse’s feet independently? Yes No
Can your child tack a horse independently? Yes No
Can your child ride a horse at the walk independently? Yes No
Can your child ride a horse at the trot independently? Yes No
Can your child ride a horse at the canter independently? Yes No
Can your child ride a horse going over ground poles independently? Yes No
Can your child ride a horse going over cross rails independently? Yes No
Can your child jump a horse independently? Yes No
Has your child ever had a bad experience with a horse? Yes No
If yes, please describe: ________________________________________
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Page 2...Brewer Equestrian Center Summer Camp
What do you and your child wish to gain from this summer camp experience?
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Is there anything else that we should know about your child in order to make his or her week at camp more enjoyable?
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Is before care or after care needed? Yes No
If yes, please specify the session or sessions you need before care and/or after care and what you need.
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Total Cost Of Camp: $225.00 deposit of $75.00 at time of registration leaves a balance of $150.00 due the first day of camp session. (we do offer before and/or after care for additional fees)

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Parent’s signature

Health Info and Medical Authorization

Health Form & Emergency Medical Authorization
I am aware that my child is participating in a summer riding camp at Brewer Equestrian Center..
I, ____________________________________________ (parent/guardian) give permission to Brewer Equestrian Center and its staff and volunteers to act on my behalf of ___________________________________________ (my child) in the event of a medical emergency.
Child’s Name: __________________________________________
Child’s Address: ________________________________________
Child’s Date of Birth: _______________________
Family Physician: _______________________________________
Physician’s telephone No.: ________________________________
Dentist: __________________________________________
Dentist’s telephone No.: _____________________________
Insurance Company: ______________________________________
Policy No.: ______________________________________________
Name of the insured: ______________________________________
If a parent or guardian cannot be reached, please contact:
Name: __________________________________ Tele. No.: ______________
Name: __________________________________ Tele. No.: ______________
Name: __________________________________ Tele. No.: ______________
Please indicate any additional health or medical concerns that Brewer Equestrian Center should be made aware of:
______________________________________________________________________
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(Use the reverse side if necessary.)
Does the child have any of the following: (check applicable)
___Asthma ____Seizures ____ Severe Allergies ____Diabetes ___Special Diet
Please explain: _______________________________________________________
Any physical limitations?_____________________________________
Does the child require medication? _______________________________
Is the child able to self administer?___________________________________
　
　
Parent Signature: ______________________________ Date: _______________

Permission To Print and Publish

Brewer Equestrian Center

Permission To Print and Publish

We often find ourselves taking pictures (and even videos) of our students at work. This gives our students a memento, and also can be used as a learning tool for our more advanced riders.

We do have a active webpage and we do like to frame photographs to hang in the office at the barn and we put some of these photos in advertisements. We are at times featured in certain newspapers and equine periodicals, as well.

In order to use a picture of you, or your child, we need written permission.

By signing below you are granting Brewer Equestrian Center permission to use photos/videos of your child for the express purposes of only Brewer Equestrian Center.

Student’s Name: __________________________________

Parent or Guardian Signature: ____________________________________

Date:_________________________________________________