2010 Summer Camp Application
Personal Information
Child's Name:
 Child's Nickname:
Child's Age:
 Child's Gender:
 Child's Height:
 Child's Weight:
Child's Date Of Birth:
Child's T-Shirt Size:
Parent's Name(s):
Street Address (no P.O. Box):
Mailing Address (if different from above):
City:
 County:
 State:
 Zip:
Home phone number:
 Work phone number:
 Cell phone number:
Your email address:
 Your Fax Number:
Child's
Equestrian
Experience:
Medical and Insurance Information
List any illness or allergies:
List any medications and dosages:
Insurance Policy Holder's Name:
Insurance Company:
Employer's Name and Address:
Group Policy Number:
Parent or Camper Comments
Private Horse Information or Camp Horse Preference
Horse Name (private or camp) :
 Horse Age:
 Horse Breed:
Feeding and Other Instructions:
Camp Session Selection
Girls New Beginner Camp
 June 6 - 12
Girls Beginner / Intermediate Camp
 June 13 - 19
Girls Intermediate Camp
 June 20 - 26
Girls Advanced Camp
 June 27 - July 3
Girls Advanced Camp
 July 4 - 10
Boys Camp
 July 11 - 17
New Beginner Camp - This camp is for children with very little or no experience with horses. Children will be restricted to walking on
the horses unless otherwise directed by the Camp Director. This camp will focus on learning the basics of proper riding, basic horse
care, basic tack upkeep.

Beginner / Intermediate Camp - This camp is for children who have been around horses, and maybe gone on a few trail rides, but would
like to improve their riding skills, and become familiar with the daily aspects of horses. This camp will focus on achieving intermediate
camp riding abilities, with pattern riding, team work maneuvers, second level horse care,

Intermediate Camp - This camp is for children with some riding experience, who are capable of controlling their horse at a trot or
equivalent gait. Children will be restricted to a trot or equivalent gait unless otherwise directed by the Camp Director. This camp will
focus on second level riding, learning collection, ring maneuvers, more advanced horse care, basic medical care.

Intermediate/Advanced Camp - This camp is for children with good riding experience, who are capable of controlling their horse at a
canter. Children will be restricted to a canter unless otherwise directed by the Camp Director. This camp will focus on high second level
and the beginning of advanced level riding, learning the uses of collection, advanced ring maneuvers, more advanced horse care and basic
medical care. This camp is best for kids that want to go faster, but are not yet ready for serious speed or concentrated ring maneuvers.

Advanced Camp - This camp is for children with strong riding experience, who are capable of controlling their horse at the canter or
lope. Children will be permitted to canter or lope their horses in controlled situations. This camp will focus on advanced level riding,
learning dressage maneuvers, reining patterns, bareback riding, and drill team maneuvers, along with professional horse care (show
horses) and basic veterinary care.
Payment Options
$ 50 deposit per child due no later than April 1, 2010 - Balance due no later than May 15,2010 - Camp fee $ 550  per child
Name on Card:
 Card Type:
 Expiration Date:
Card Number:
 Security Code (last three numbers on back of card):
Billing Address:
 Amount to Charge to Card:
Camp Agreement
I, the undersigned, do hereby agree to the terms, regulations and conditions of the Bar Fifty Ranch Summer Camp and do hereby release Bar Fifty Ranch, it's
owners, subsidiaries and employees of any responsibility for injury, damage or death to my child or my child's belongings while said child is at the Bar Fifty Ranch,
furthermore, I understand that under Arkansas law, an equine activity sponsor is not liable for an injury to, or the death of, a participant in equine activities
resulting from the inherent risk of equine activities.
I have read and understand the rules of the Bar Fifty Ranch Summer Camp and both I and my child agree to follow said rules.
In consideration, therefore, for the privilege of riding and participating in any activities offered at the Bar Fifty Ranch, located at 18044 Hwy 84, Bismarck, AR
71929, the undersigned does hereby agree to hold harmless and indemnify Bar Fifty Ranch, it's owners, subsidiaries and employees and further release them from
any liability or responsibility for accident, damage, injury, illness or death to the undersigned or to the child of the undersigned enrolled in the Bar Fifty Ranch
Summer Camp or participating in any and all activities offered by the Bar Fifty Ranch while on the premises.
Parent or Legal Guardian Signature:
 Date
Upon receipt of your application you will receive confirmation of reservation of selected Summer Camp opening or will be
notified if the preferred camp is full. Charges to Credit card made only if opening in selected camp is available.
Please call the Bar Fifty Ranch at (888) 829-9570 to be sure there is an opening in the camp of your choice !
"Bar Fifty" is a registered trademark of Bar Fifty Ranch.
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