The Camp at Beechwood Farm
1_____ Survivalist Campout
ages 9-14
2_____Backyard Bible Camp
ages 5-14
3_____Adventure & Exploration Day
ages 5-14
4_____Adventure & Exploration Overnight Camp ages 8-14
5_____Treehouse Art Campout
girls ages 8-12
6_____Treehouse Art Campout
boys ages 8-12
7_____Treehouse Art Campout
girls ages 8-12
April 15-16, 2016
June 27-July 1, 2016
July 11-15, 2016
July 24-29, 2016
Aug. 8-9, 2016
Aug. 10-11, 2016
Aug. 12-13, 2016
$95.00
$125.00
$325.00
$585.00
$95.00
$95.00
$95.00
Description: This is our ninth year of working with the Rixeyville Riders to host camps at
Beechwood View Farm, and the events and activities just keep getting better and better! This year
we offer the camps with various themes listed above. Check one or more camps for which you would
like to register.
1. Survivalist Camp, April 15 at 6:00 PM—April 23 at 1:00 PM. Build your own shelter in the
forest, learn to start a campfire, prepare and cook your meals over the fire, purify water, use
natural objects for survival. Meals and supplies included. Boys and girls ages 9-14.
2. Backyard Bible Camp, June 27-July 1, 9:00-1:00 daily. Bible based stories, skits, crafts, songs,
and games. Interaction with horses and ponies (pony rides but NO riding instruction), nature
activities, and friendship building activities. Non-denominational. Bring lunch and water
bottle. Ages 5-14.
3. Adventure & Exploration Day Camp, July 11-15 from 9:00-4:00 daily. Emphasis on horseback
riding and horse-related activities. Also, river day, hiking, science and nature, architecture,
creative activities, arts and crafts, games, and more. Thursday night camp out for ages 9 and
up (additional fee of $35). Bring lunch and water bottle. Friday camp ends at 1:00. Ages 514.
4. Adventure & Exploration Overnight Camp, July 24-29. Drop off on July 24 after 5:00 PM, pick
up July 29 at 1:00. Tube the rier, rier day, hiking, horseback riding, creative activities, team
activities, science and nature, architecture, astronomy, campfire each night. Tent camping.
All meals, snacks, drinks, tubes, and tents provided. Bring sleeping bag, flashlight, camp play
clothes for the week, toiletries, towels. Ages 9-14.
5. Treehouse Art Camp. Create fun art projects using paint, clay or other medium. Camp out in
the treehouse with friends after enjoying campfire and s’mores. All art supplies, meals and
snacks included. See above for dates.
Owner of Beechwood View Farm, Robin Lanham has been a teacher and elementary school counselor
for 25 years, leader of the Rixeyville Riders Horse 4-H Club in Culpeper County for 8 years, and Camp
Director for the Beechwood Farm summer camps for 9 years. She has degrees in Elementary
Education, Reading Specialist, and Guidance & Counseling K-12. She has recently received her
EAGALA certification for Equine Assisted Growth and Learning.
Camp Volunteers and Assistants include parents of members of the Rixeyville Riders 4-H Club, adult
volunteers, teachers, special guests; as well as Rixeyville Riders 4-H Members, and youth volunteers
ages 15-22.
Registration Form
Print, complete and mail this 5-part form with check payable to “Robin Lanham”,
13147 Beechwood Lane, Rixeyville, VA 22737
Questions? Email Robin at rixey@msn.com or phone 703-409-8331
The Camps at Beechwood View Farm Registration Form
Part I. Payment Options
Payment Options: Please check to indicate your choice of payment options.
List camp(s) your child is registering for:_____________________________________________
_____1. Paid in full by March 15st
Early bird discount subtract 5%
_____2. Add $35.00 for Thursday night camp out participant for Adventure Day Camp if your
child chooses to participate, ages 9 and up
_____3. Paid in full after March 15th
Payments must be made in order for your spot to be held in the camp.
Fees are nonrefundable, except in case of emergency.
Total enclosed:_________
***Make Checks Payable to “Robin Lanham” ***
II. Registration: Please Type or Print Clearly
Participant’s Name:____________________________Age:_______M/F___
Child’s t-shirt size: Youth M Youth L
Adult S
Adult M
Adult L
Your child’s swimming ability: Non-swimmer Intermediate
Advanced
*Non swimmers are required to wear a life jacket for River Day.
Parent Name: __________________________Email:_________________
Parents Employer______________________________________________
Phone:______________________ Cell: ____________________________
In case of emergency—best number to call: ________________________
Any information we should know about your
child:__________________________________________________________________
______________________________________________________________________
______________________________________________________________________
III. Health Information
In the case of a medical emergency, every effort will be made to contact a parent
immediately using emergency contact number listed above.
Physician and Insurance Information
Family Physician Name:_______________________________Phone:_________________________
Dentist Name:______________________________________Phone:__________________________
Insurance carrier:____________________________________Policy ID#______________________
Medical conditions that may effect your child while he/she is at camp:
_________________________________________________________________________________
Does your child have any other conditions, medically or behaviorally, that we should be aware of:
_________________________________________________________________________________
Note: We ask that children comply with camp rules, display respectful and helpful behavior toward
others, and kind behavior toward animals, at all times.
Medications that your child takes_______________________________________________________
Will your child need any medications while at camp?______________If so, please list with
instructions:________________________________________________________________________
IV. Beechwood Farm Waiver
Beechwood Farm, 13147 Beechwood Ln., Rixeyville, VA 22737
Pursuant to Virginia Cod 3.1-796.130, the Undersigned acknowledges that there are risks inherent in
equine and farm activities, including but not limited to the following:
(i.)
the propensity of an equine to behave in dangerous ways which may result in injury to
the participant;
(ii.)
the inability to predict an equine’s reaction to sound, movements, objects, persons, or
animals, and
(iii.)
hazards of surface or subsurface conditions. The undersigned further acknowledges
that there are inherent risks in camp activities including but not limited to hiking, sports,
games, camping, river walk, hayrides, being around animals such as dogs, cats, horses,
ponies, chickens; and all other camp activities. Such inherent risks are dangerous and
may result in serious injury and /or death.
I agree to indemnify and hold harmless Beechwood Farm, its owners, its assignees and each
employee of Beechwood Farm from and against all claims and liabilities including incidental cost and
expenses, for injury to or death of any person or persons, or for loss or damage to any property,
including any horse, arising from or in any way connected with the performance of services by
Beechwood Farm, its assignees or any employee.
I state that I and (if applicable) my minor (under 18 years) child (children) are fully and appropriately
covered by personal medical insurance, as listed above (II. Health Information).
I, the undersigned, allow Beechwood Farm or its representatives, to sign for treatment in any
licensed medical facility. I also agree to be financially responsible for all treatment authorized by
Beechwood Farm or its representatives. I further agree that a clear photocopy of this document shall
serve the same purpose as the original.
Minor child(ren) Please print clearly:
_________________________________
_________________________________
_________________________________
_________________________________
Photo permission: In signing this waiver, I also give permission for my child’s photo to
be used in publications and on the Beechwood Farm web page.
Adult Participant, Parent, or Guardian: _____________________________________
Youth/Child Participant:__________________________________________________
Address: ___________________________________________________________
Email:___________________________________
Phone: Home___________________cell_________________work_____________
Authorizing Signature: Sign _____________________Print_____________________
Date:__________________________________
Thank you for enrolling in the Camp at Beechwood View Farm! We look forward to the
fun summer days of camp!
Robin K. Lanham, Owner
Camp Director
Beechwood Farm, Rixeyville, VA