infoform

2008 J-Bar-M Ranch HORSE CAMP Application 

Camper’s Name: 

First _______________________________  Middle _________________________  

Last ______________________________  Birthdate  ______/________/_________ 

Age on Arrival______________

Street Address: _____________________________________________________________

City _____________________________________  State ______________ Zip _________ 

Phone Number(s) ____________________ (hm)   _______________________(work/cell)

Name of School ______________________________________________________________ 

School Grade (Sept 2008)  ___________________

Camper Email address: ________________________________ 

Parent Email Address:___________________________________ 

Father: ___________________ Occupation:_________________ Business Phone:______________ 

Mother: ___________________ Occupation:_________________ Business Phone:______________ 

Emergency Contact (in the event that you are unavailable):________________________

Phone #:_____________________________Relationship:____________________________ 


     ***************EMERGENCY MEDICAL RELEASE******************

Accident and health insurance is required. Parent/guardian is responsible for 
payment of all charges related to the medical or dental services for the camper. 
This form may be photocopied for use out of camp, as in field trips, etc.

I hereby give my permission for the J-Bar-M Ranch Camp Directors to assure the 
health and safety of my child through such medical attention as may be deemed 
necessary in case of an emergency and/or when  parents and summer emergency contact 
are unavailable. ___________________ (signature)

Does this applicant have Medical Insurance? ___YES        

INSURANCE COMPANY ___________________________   POLICY Number __________________

__________________________________________
    Signature of Parent or Guardian 

Insured Parent’s SS#____________________ Date ________________  

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PLEASE MARK SESSIONS DESIRED
___ June 09 - June 13	Beginners (Limited to 6 Campers)
___ June 16 - June 20	Intermediate (Limited to 6 Campers)
___ June 23 – June 27   Advanced (Limited to 5 Campers) 

___ July 7 – July 11	Beginners  (Limited to 6 Campers)
___ July 14 – July 18 	Intermediate (Limited to 6 Campers) 
___ July 21 – July 25   Advanced   (Limited to 5 Campers) 

___ July 28 – August 1   Beginners (Limited to 6 Campers)
___ August 4 – August 8  Intermediate (Limited to 6 Campers) 
 

Tuition is $225 per week and includes all in-camp activities, and lessons. 
Campers DO NOT NEED CASH at camp. Campers are responsible for bringing a sack lunch.

OFFICE USE ONLY 
Early Registration:_______ Deposit_______ #______ Date Rec._____ Ack._____ 

      
Please tell us briefly about your riding experience (feel free to use extra paper 
for this and/or special interests below if needed): 
________________________________________________________________________________

________________________________________________________________________________.

If you are a new camper, how did you hear of the J-Bar-M ranch? 
__________________________________________________________________________________ 

Returning campers, which horse did you ride last summer?_________________________. 

Please tell us any areas of special interest, comments, goals or concerns about 
the camper’s experience (this is especially helpful for first time campers)
____________________________________________________________________________ 

____________________________________________________________________________ 


PAYMENTS, POLICIES, WAIVERS & PARENT INFORMATION 

A deposit of $25.00 per each week must accompany 
your application. Deposit fee will be applied to the total tuition.
Balance of tuition is due ONE WEEK BEFORE CAMP STARTS! 
 
APPLICATIONS SUBMITTED WITHIN ONE WEEK OF CAMP MUST INCLUDE FULL TUITION! 

Please make checks payable to:  J-Bar-M Ranch. Refund of deposit (minus 
$10 office fee) and all payments will be made for cancellation if requested ONE 
WEEK before the start date of camp. After that, there are NO REFUNDS for any reason. 
There is no tuition adjustment for late arrivals or early departures.  

All campers are expected to follow camp rules and policies. There will 
be no refund for dismissal due to behavioral, emotional or psychological 
situations that are disruptive to the camp program or harmful to the camper. 




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Possession of alcohol, illegal drugs or weapons will result in immediate removal 
from camp with no refund. Both parents and campers understand that the J-Bar-M 
Ranch takes reasonable precautions to insure that programs and activities at the 
ranch are supervised by qualified personnel in a safe and responsible manner. 
However, parents and campers understand that these activities involve certain 
risks and may include, but are not limited to, horseback riding, ropes course, 
water sports, land sports, archery, riflery, canoeing, swimming, rock climbing or 
hiking. Parents and campers recognize these risks and agree to assume these 
risks by attending or allowing the camper to attend the J-Bar-M Ranch and 
participate in these programs. It is understood by parents and campers that any 
photographs, videos, quotes, etc. taken at camp may be used by the J-Bar-M Ranch 
forart, advertising and promotional materials. If you have an objection to this, 
you mustdo so in writing before your child attends. Camper rosters are printed 
at the conclusion of the summer so families interested in the next season may have 
the opportunity to speak with experienced camp families about their J-Bar-M experience. 
If you have an objection to this, you must do so in writing by the end of the summer. 

We (parent and camper) understand that an enjoyable wholesome experience at the 
J-Bar-M Ranch depends on a positive attitude, a desire to contribute meaningfully 
to the whole group and a willingness to participate enthusiastically in all of the 
activities offered at the Ranch. We have read, understood and agree to abide by the 
above rules, payment schedule, refund policy, application policy and all other terms 
as stated above. 

Camper Signature:___________________________________ 	Date: ______________________

Parent Signature: ______________________________________  Date: ________________________
If this sounds like something that might interest you- call, or e-mail, John or Melanie and ask for more information. You can get the answers to your questions, and then PRINT and CLOMPLETE THIS Application Form and return it via U.S. Post Office.
Our Address is: J-Bar-M Ranch, 3997 Sugar Grove Valley Rd, Harriman, TN, 37748
OR
You can copy and paste this form to a WORD document, Complete the form on your computer, save it to your hard drive, and return via E-mail as an attachment to : trailboss@j-bar-m.com , Or call us at: (865)435-0380 (office) or (865) 640-7737 (cell)
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