SLIDE RANCH
SUMMER CAMP REGISTRATION
Registration is to be completed by mail only. Please allow 2-3 weeks for notification of
acceptance or wait list status. Please
complete a separate application for each child.
Camper’s
Name: __________________________________________________ Female: ____ Male:
____
Birth
date: _____________________________ Age
during camp: ____
Parent or Guardian Name (primary contact):
_______________________________________________
Address:
___________________________________ City: _________________ Zip:
_____________
Daytime Phone:
_______________ Home Phone:
_________________Cell Phone: _______________
Fax: ____________________ E-mail address:
______________________________ -------------_______________
Parent or Guardian Name (secondary contact):
_____________________________________________
Address:
___________________________________ City: _________________ Zip:
______________
Daytime Phone:
_______________ Home Phone:
_________________Cell Phone: ________________
Fax: _____________________E-mail address:
______________________________________________
CAMP SESSION(S)
In
how many Camp Sessions would you like to enroll your child? ________ (Limit of
3 sessions.)
ˇ
June 9 – 13 Ranch
Rangers (ages 5 – 8) ˇ July 14 – 18 Jr. Camp Counselors (ages 13 – 18)
ˇ June 16 – 20 Ranch Rangers
(ages 5 – 8) ˇ July 21 – 25 Junior Farmers (ages 8 – 12)
ˇ June 23 – 27 Junior Farmers
(ages 8 - 12) ˇ July 28 – Aug. 1 Ranch Rangers (ages 5 – 8)
ˇ *June 30 – July 3 Ranch
Rangers (ages 5 - 8) ˇ Aug 4 – 8 Junior Farmers (ages 8 – 12)
ˇ July 7 – 11 Ranch Rangers (ages 5 – 8) ˇ Aug 11 – 15 Ranch Rangers (ages 5 – 8)
ˇ July 14 – 18 Ranch Rangers (ages 5 – 8) ˇ Aug 11 – 15 Jr. Camp Counselors (ages 13 – 18)
*No Camp on Friday, July 4th
PLEASE NOTE: In the
event we are not able to accommodate your first request, we will try to place
your child into a second choice session or on a wait list until space
permits. 2nd choice session:
_________________
SLIDE RANCH CAMP HISTORY
Has
your child been to Slide Ranch Day Camp before? ˇ YES ˇ NO If
so, which year(s)?____________________
We
may be able to place your child with a friend, however we cannot guarantee that
a request will be granted. A friend
must be within one year of your child’s age.
More than one request cannot be accommodated.
We thank you for your cooperation.
Requested friend:
________________________________________________________
PAYMENT INFORMATION
(Ranch
Rangers $325/week; July 4th week $260,Junior Farmers $360/week;
$425/overnight, Junior Camp Counselors $100/week)
Payment by: ˇ Check (made payable to Slide Ranch)
ˇ VISA/
MasterCard# _______________________________________ Exp. _________
Name on Credit Card:
__________________________________________________
Amount Enclosed for Camp(s): $____________________
DON’T FORGET THE SLIDE RANCH SCHOLARSHIP PROGRAM
Your generosity will help a low-income
child experience the beauty of Slide Ranch.
Please contribute today!
Amount enclosed for the Slide Ranch Scholarship: $ ____________________
Total Payment $_____________________
CANCELLATION & CHANGE POLICY
If
you must cancel your registration you will be eligible for a full refund (minus
a $50 processing fee) if the cancellation is made at least 6 weeks before the
camp starting date. Cancellations received with less than 6
weeks’ notice will not be eligible for any refund unless a replacement is
available to take your camper’s spot.
If
you would like to reschedule your camp week, a $25 processing fee will be
charged and changes will be accommodated only when there is space available.
I have read and agree to abide by
the cancellation policy.
X
Signature of
parent or guardian
Date
Child’s
Name:
________________________________________________________________________
Primary
emergency contact name: ________________________________________________________
Daytime
phone number:
_____________________________Relationship: ________________________
Secondary
emergency contact name:
______________________________________________________
Daytime
phone number:
_____________________________Relationship: ________________________
Doctor’s
Name: _____________________________ _____Doctor’s Phone Number:
__________________
Does
your child have any allergies or medical conditions we should know about? Please specify what your child is allergic
to and what reaction is typical. It is
especially important that we learn about allergies to bee stings and
foods. ___________________________________________________________________________________
Will
your child be taking any medication while at Slide Ranch? If so, please detail. ____________________
________________________________________________________________________________________
In
the event of an emergency, if we cannot reach you, please indicate your permission
to authorize emergency care by signing below:
X
Signature of
parent or guardian
Date
IMAGE RELEASE
I
authorize that any photographs, motion pictures and/or video recordings taken
of my child during his/her participation in a Slide Ranch program may be used
by Slide Ranch for the purpose of promotion in perpetuity. I understand that
these photographs, motion pictures and/or video recordings shall be fully owned
by Slide Ranch and shall make no claim against Slide Ranch or the photographer
for their use for any reason whatsoever.
It
is understood by the party signing this document that the scope of the Consent
is as described above, and that there will be no consideration, monetary or
otherwise, required from Slide Ranch in exchange for such consent.
X
SLIDE RANCH SCHOLARSHIP
PROGRAM
Scholarships
are available for low-income families, and will be awarded on the basis of need
and availability. Please indicate how
much of the normal camp fee you can afford:
$_______________
*Note:
Families applying for scholarship assistance should not send in a fee with this
application.