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2016 Camp Application June 19th – June 25th Dubuque County Fairgrounds Completed forms and registration fee may be mailed to: EIHPC, Attn: Shawn Strief, 5203 McAllister Rd., Cascade, IA 52033
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About the Eastern Iowa Horse & Pony Camp The annual camp known as, Horse & Pony Camp, began in 1971 with the Dubuque County Trailblazers 4-H Club. In 2013, the Trailblazers made a difficult decision to cancel camp. For two years, Horse & Pony camp was not offered to our youth. In the summer of 2014, it was decided to form a new organization that would take over the responsibility of this annual equine educational camp for youth. The Eastern Iowa Horse & Pony Camp, Inc. (EIHPC) was formed. Our founding members were Rodney Carroll, Katie Kotz, Shawn Strief, Kevin Kotz, Matt King, Nick Meyer, Jason Burke and Dr. Katie Merkes.
Eastern Iowa Horse & Pony Camp Mission The mission of the Eastern Iowa Horse & Pony Camp is to provide an educational opportunity for boys and girls to learn and improve their horsemanship and equitation skills through special sessions in advanced western riding, English riding, games, roping, and showmanship. Furthermore, our mission is to facilitate the makings of new friendships and bonds amongst our campers whom share a common passion for horses.
The annual horse and pony camp is a week-long residential camp that is open to boys and girls that have completed fourth through 12th grade. The camp is also open to those that have completed third grade, pending that the camp is not full. Youth will bring a horse to camp and participate in the following daily activities: • Two, one-hour riding lessons with groups of eight or less with instructors that have been successful in the equine industry and have experience with instruction • Two, 45-minute based classroom instruction sessions that bring in guest speakers to discuss and demonstrate topics related to the equine industry • One, one-hour elective of the camper’s choice o Some electives may include but not limited to: barrels, advanced western pleasure, showmanship, dressage, reining, roping, groundwork, saddle cleaning, grooming for show, and competitive judging The camp will also provide daily meals and evening activities. Your camp fee also covers a box stall for the camper’s horse, camp T-shirt, and room and board. Volunteers are a vital part to the Eastern Iowa Horse & Pony Camp. We ask that parents find a time to volunteer to aid in hosting a successful camp that can continue to be affordable. Facebook.com/EIHPC
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Eligibility, Requirements, & Application Process, Fees Eligibility & Requirements The camp is open to boys and girls that have completed fourth grade and up through 12th grade. If camp is not full by the March 31st application deadline, those who have completed the third grade in the 2015/2016 academic year will also be considered for camp attendance. The EIHPC Board of Directors will review those submitted applications where the potential camper has only completed the third grade. You will be notified if your application has been approved. Priority will be given to those applications that have strong volunteer availability. Campers are required to bring their own horse or one that they have borrowed or leased as well as necessary tack. We ask that the campers are able to control and care for their horse. This includes but is not limited to: feeding, watering and cleaning their horse’s stall. Campers should also be able to saddle and bridle their horse. Volunteers will be in the barn to assist campers in lifting, tightening and checking saddles. Campers must carry their own insurance on themselves, their horse, and their tack. The camper is responsible for providing their own hay, other feed if needed, and bedding for their horse’s stall. All campers must have an ASTM or SEI approved riding helmet. This helmet must be worn at all times while mounted on the horse. Appropriate riding boots are also required by all campers while mounted on their horse. Horses and ponies that are brought to camp should be experienced and well broke. Horse and ponies less than four years of age, unbroken or very green horses, stallions, or mares with foals at their side will not be allowed. Please make sure that your horse or pony is in good condition for camp. We recommend your horse be ridden at least one hour per day for three weeks or more prior to camp. We also recommend that a professional farrier trim or shoe your horse/ pony three to four weeks prior to camp. All horses are required to have health papers dated within 30 days of the camp by a licensed veterinarian. It is required that your horse/pony be up to date on five-way, West Nile and Rabies vaccinations. All out of state horses are required to have a negative Coggins test.
Application Process & Camp Registration Fee A hard copy of the following application and registration fee must be postmarked by March 31, 2016. Applications will be accepted until the camp is full; once the camp is full, campers will be put on a waiting list. Consideration will be given to those whose parents volunteer their time throughout the camp week. Checks will be cashed upon receipt. There is no refund on the registration fee. A late registration fee will be accessed for applications postmarked after March 31, 2016. You will be notified by email whether or not your camp application was accepted. An acceptance email will be sent out bi-monthly on the 1st and 15th. After May 1, a final email will be sent that includes supplies needed, health forms, schedules, etc. Please watch our Facebook page for updates as well.
2016 Camp Registration Fee: $375.00 For applications postmarked on or before 3/31/2016 2016 Late Registration Fee: $425.00 For applications postmarked after 3/31/2016
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Eastern Iowa Horse & Pony Camp Contact Information Mailing Application and Registration Fee Applications are due March 31, 2016. Only hard copies of the application with registration fee payment will be accepted. We would prefer all applications be typed into the provided fillable form. Eastern Iowa Horse & Pony Camp Attn: Shawn Strief 5203 McAllister Rd. Cascade, IA 52033
Prior to Camp, Please use the Following Contact Information Email:
[email protected] Facebook: www.facebook.com/EIHPC Katie Kotz: 563-599-6528 Shawn Strief: 563-580-6602
During Camp, Please use the Following Contact Information Email:
[email protected] Facebook: www.facebook.com/EIHPC Rodney Carroll: 563-564-1195 Nick Meyer: 563-343-2670 Kevin Kotz: 563-590-0023 Jason Burke: 563-249-5124 Matt King: 563-543-0064 Dr. Katie Merkes: 563-590-0145
Stay Up to Date By Following our Facebook Page! Facebook.com/EIHPC
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Camper Application Form The following pages, 4-8, must be postmarked with the $375.00 registration fee no later than March 31, 2016. Any applications postmarked after this date will be assessed an additional $50.00 late fee, which would bring the total camp registration fee to $425.00. The forms and payment should be mailed to: Eastern Iowa Horse & Pony Camp, Attn: Shawn Strief, 5203 McAllister Road, Cascade, Iowa 52033
General Camper and Parent/Guardian Information Camper Name:
Sex: ☐ Female ☐Male
Age (as of June 19, 2016):
15/16’ Grade Completed:
Mailing Address: City: ____________________________
State: _______
Zip: ___________
Parent or Guardian Name(s): Parents or Guardian Home Number:
☐Not applicable
Parents or Guardian Cell Number:
☐Not applicable
ĂŵƉĞƌĞůůNumber:
Not applicable
Email is our main point of contact. At least one email address is required for application submission.
Camper Email:
☐Not applicable
Parents or Guardian Email (1):
☐Not applicable
Parents or Guardian Email (2):
☐Not applicable
Camp T-Shirt One shirt is included with registration. Additional shirts may be purchased for $13.00 per shirt. Please include payment for additional shirts with your registration fee.
Camper T-Shirt: Adult sizes Kid sizes
☐S
☐M
☐L
☐XL
☐S
☐M
☐L
☐XL
☐XXL
Additional T-Shirt(s): Select Type Select Type
Select Size Select Size
Enter Quantity 0
X $13.00/shirt = $ $0 Total Due
Select Type Select Type
Select Size Select Size
Enter 0 Quantity
X $13.00/shirt = $ $0 Total Due
Select Type Select Type
Select Size Select Size
Enter Quantity
X $13.00/shirt = $ Total $0 Due
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Camper Application Form Iowa Code Chapter 673 WARNING: Under Iowa law, a domesticated animal professional is not liable for damages suffered by, an injury to, or the death of a participant resulting from the inherent risks of domesticated animal activities, pursuant to Iowa Code Chapter 673. You are assuming inherent risks of participating in this domesticated animal activity. A number of inherent risks are associated with a domesticated animal activity. A domesticated animal may behave in a manner that results in damage to property or an injury or death to a person. Risks associated with the activity may include injuries caused by bucking, biting, stumbling, rearing, trampling, scratching, falling, or butting. The domesticated animal may react unpredictably to conditions, including, but not limited to, a sudden movement, loud noise, and unfamiliar environment, or the introduction of unfamiliar persons, animals, or objects. The domesticated animal may also react in a dangerous manner when a condition or treatment is considered hazardous to the welfare of the animal; a collision occurs with an object or animal; or a participant fails to exercise reasonable care, take adequate precautions, or use adequate control when engaging in a domesticated animal activity, including failing to maintain reasonable control of the animal or failing to act in a manner consistent with the person’s abilities. Sign below to indicate that you have read and understand the above statement. Camper Signature: ____________________________________________________
Date: _________________
Parent/Guardian Signature: ____________________________________________
Date: _________________
Any Camper May be Sent Home for any of the Following Reasons: 1. Leaving the grounds without camp staff permission 2. Leaving the dorm units after curfew without permission 3. Possession and/or use of alcoholic beverages or other drugs 4. Possession and/or use of Tobacco (smoking or chewing) 5. Switching stalls without permission 6. Causing intentional damage to public or private property - camper will be charged for repairs 7. Inappropriate conduct at camp 8. Possession of weapons, knives, or other dangerous objects 9. Possession of a cell phone - If a camper needs to call home, they are welcome to use one of the volunteer’s phones. If a parent needs to contact their camper, please call Rodney, Kevin, Matt, Jason or Nick. Any camper sent home for any of the above reasons will receive no refund, whole or part, and will not be considered for camp next year. We, the parent(s) and camper, have read and agree to abide by the rules and conditions as stated above. The above named prospective camper has permission to take part in the Eastern Iowa Horse and Pony Camp. We understand that applicant acceptance makes the registration fee non-refundable except in the instance of camp cancellation, in which case your money will be refunded. Camper Signature: ____________________________________________________
Date: _________________
Parent/Guardian Signature: ____________________________________________
Date: _________________
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Camper Placement Questionnaire The information below will be used to place your camper into a riding group. We place campers based on the following criteria: age, riding ability/experience, riding areas of interests and geographic location.
Basic Camper Information Camper Name:
Sex: ☐ Female ☐Male
Age (as of June 19, 2016):
15/16’ Grade Completed:
City:
County:
Have you been to this camp before?
☐ YES
☐NO
Camper Riding Ability What is your riding level? ☐ Beginner ☐Advanced Beginner ☐Intermediate ☐Advanced How many years have you been riding? Please indicate how well you can do these listed skills: 1=Not at All
2=Somewhat
Walk: Choose Level 1
1 Trot/Jog: Choose Level
Stop: Choose Level 1 Trail Obstacles: Choose Level
1
3=Well
4=Exceptional
Collected Lope/Canter: Choose Level 1
Back: Choose Level 1
Post: Choose Level 1
Neck Reining: Choose Level 1
1 Correct Leads: Choose Level
Side Pass: Choose Level 1
Saddling: Choose Level 1
Bridling: Choose Level
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What does your camper need to work on with their riding skills and horsemanship?
Camper Areas of Riding Interest What types of riding does your camper regularly participate in? Please check all that apply. ☐ Trail/For Fun ☐Western Pleasure/Show ☐ English Riding ☐Jumping/Dressage ☐ Barrels/Speed ☐Ranch Horse ☐ Roping/Rodeo ☐Other: If possible, what types of electives would you like to see us offer at camp?
Special Requests We cannot guarantee a request but if possible, who would your camper like to be stalled by for camp? Please only list one other camper’s name.
OFFICE USE ONLY:
Camper# __________ Riding Group Assigned: ________________
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Volunteer Sign Up In order for us to operate as a 24-hour-a-day camp for one week at such a low fee, our camp relies HEAVILY on volunteer help. Each camper must have at least one parent or guardian volunteer. Please fill in the form below and a volunteer schedule will be emailed to you prior to the start of camp. Thank you!
Basic Volunteer Information Volunteer Name:
Camper Name:
Volunteer Email:
Volunteer Phone:
Additional Notes/Comments:
Please circle the spot(s) of preference.
Nurse
Sunday 7 pm – 8:30 am 7 pm – 8:30 am 6 pm – 10 pm
Barn Help
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Kitchen & Snack Bar
3pm – 7:30pm
ALL DAY 7am – 2pm 2pm – 8pm
ALL DAY 7am – 2pm 2pm – 8pm
ALL DAY 7am – 2pm 2pm – 8pm
ALL DAY 7am – 2pm 2pm – 8pm
ALL DAY 7am – 2pm 2pm – 8pm
Clean Up & Serving 7am – 10am
Daytime Chaperone Sunday Night Saturday Show
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ALL DAY ONLY XXXXXXX
ALL DAY ONLY XXXXXXX
ALL DAY ONLY XXXXXXX
ALL DAY ONLY XXXXXXX
ALL DAY ONLY XXXXXXX
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XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
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Work 1 shift at Show
Girls Dorm Boys Dorm
Game Monitor 7pm – 9pm XXXXXXX
Monday 8 pm – 8:30 am 8 pm – 8:30 am ALL DAY 7am – 1pm 1pm – 6pm 6pm – 10pm ALL DAY ONLY
Tuesday 8 pm – 8:30 am 8 pm – 8:30 am ALL DAY 7am – 1pm 1pm – 6pm 6pm – 10pm ALL DAY ONLY
Wednesday 8 pm – 8:30 am 8 pm – 8:30 am ALL DAY 7am – 1pm 1pm – 6pm 6pm – 10pm ALL DAY ONLY
Thursday 8 pm – 8:30 am 8 pm – 8:30 am ALL DAY 7am – 1pm 1pm – 6pm 6pm – 10pm ALL DAY ONLY
Friday 8 pm – 8:30 am 8 pm – 8:30 am ALL DAY 7am – 1pm 1pm – 6pm 6pm – 10pm ALL DAY ONLY
Saturday Dorm Clean Up Dorm Clean Up 7am – 10am
Barn Clean Up
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Volunteer Duties
Boys & Girls Dorm: OVERNIGHT 8:00 PM - 8:30 AM. Bring flashlight, sleeping bag, cot or air mattress, etc. Daytime Chaperones: Supervise daily camper chores. Replenish supplies. Refill water coolers. Kitchen Help: Help with prep, serving, and clean up for all three meals. Assist in the snack bar. Barn Help: Patrol barns, check stalls, help in wash rack, assist with saddling and bridling, etc. Nurses: Daytime help 7:30 am - 10:00pm. Mark times if you can do a split shift. Saturday Dorm Clean up: Cleaning dorms, kitchen and bathrooms. Sunday night games monitor: Help monitor the Minute to Win It Games for campers to get to know each other. Saturday Show: EIHPC will contact you to schedule a shift for the Saturday Show prior to the start of camp.
We greatly appreciate volunteers who can stay all week; this helps the camp run smoothly. The success of the camp is directly attributed to the many volunteers we rely on. Thank you for your time and generosity! *Please note that if you are volunteering and planning to stay in your camper/trailer overnight, you will be responsible for paying the fee from the Dubuque County Fair Association for camping and using their electricity. The fee is $20 per day per camper/trailer. The camp will not cover this fee. However, you are welcome to stay for free in the dorms.
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Volunteer Background Check Authorization The Eastern Iowa Horse and Pony Camp is required to do a background check on all volunteers who will be helping at camp. If you filled out the above Volunteer Sign Up Form, complete and return this volunteer background check authorization form with your camper’s application.
Authorization to Release Information and Records Full Name: ________________________________________ Date of Birth: _______________________ Social Security Number (Full number is required): ____________________________________ Current Address: ______________________________________________________________
I, ________________________________________________ hereby authorize the Eastern Iowa Horse and Pony Camp, or their authorized agents, to conduct a thorough check of my past for any criminal history. This is needed by the camp for determination of my eligibility to occupy a position of trust at their camp. I authorize all persons who may have information relevant to this investigation to disclose it. I release from liability all persons, companies, and corporations disclosing this information. I hereby further authorize that a photocopy of this authorization may be considered as valid as the original. ______________________________________________________
Signature
_____________________
Date
Completed Application Forms and Registration Fee to be mailed to: Eastern Iowa Horse & Pony Camp Attn: Shawn Strief 5203 McAllister Rd. Cascade, IA 52033
