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OWEN FARM TOURS, LLC
SIMPLY FAMILY FUN " Down on the Farm"
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                                                        OWEN FARM CAMP FORM 2018
                                                    434-685-4123 or info@owenfarmtours.com



NAME: __________________________________________________AGE_______SEX______________
ADDRESS__________________________________________STATE_______ZIPCODE_______________
PHONE NUMBER/HOME_____________________WORK________________CELL__________________
PARENTS NAMES______________________________________________________________________
EMAIL ADDRESS_______________________________________________________________________
NONE ALLERGIES______________________________________________________________________
EMERGENCY CONTACT/NAME AND PHONE NUMBER_________________________________________
Please mail or bring completed form along with $42.50 non-refundable deposit to Owen Farm, 1668 Silver Creek Road, Danville, 24540. Cost of camp for one week $160 plus $2.50 sales tax. (Sibling discount is $135 plus $2.50 sales tax). If your child would like to attend more than one camp the cost is $145.00 per week plus $2.50 sales tax. Please check camp dates that you would like for your child to attend. (The cost of the first camp is $162.50and following camps would be $147.50). Daily camp prices are $42.50
#1 June 3-7_____ #2 June 10-14______ #3 June 24-28______ #4 July 8-12_______ #5 July 15-19 _____
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I give my child permission to attend and participate in all activities during farm camp at Owen Farm. I understand that all equestrian activities and zip line activities are excluded from liability insurance and I take on the full responsibility of allowing my child to work with and ride the horses and ride the zip line on Owen Farm. I have discussed with my child about the following the rules while at the farm and he/she understands there will be consequences for not following the rules. I also understand that by signing this form that I agree to allow Owen Farm to print and publish pictures taken of my child during Farm Camp. Camps are held rain or shine.

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Parent Signature

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Childs Signature 

List of People that my child/children may ride with

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