Registration Form - Castle Rock Ranch Camp

I wish to enroll my child at the Castle Rock Ranch Camp for the following session(s):*

Camper Info

Camper's Name

First Last

Nickname (if any)

Camper's Age

Date of Birth

Grade Level

Parent/Guardian Name

First Last

Parent/Guardian 2

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell 1

Cell 2

Other Phone

Email

Back-up Contact in case of Emergency

First Last

Relationship to Child

Backup Contact's Phone

Backup Contact's Phone 2

Medical

Insurance Company Name

Policy Holder's Name

Policy Number

Group Number

Special Needs

If your child has any food or chemical allergies, special medical requirements, or diet needs.

Child's Previous Camping Experience

What skills do you hope your child will gain from this camp experience?

What camp activities is your child interested in?

Where did you learn of Castle Rock Ranch Camp?

How much horseback riding experience has your child had?

Signature

I have read and agree to the terms of enrollment as detailed in this application. I understand and acknowledge that horse riding can be a dangerous activity and that my child is riding at Castle Rock Ranch at my OWN RISK. I understand that my signature on this document constitutes a complete and unconditional release of all liability, and I will not hold the owners, instructors, or employees of Castle Rock Ranch responsible for any accident, injury, property damage or loss that may occur. I further agree to abide by all rules and regulations of Castle Rock Ranch Ranch. My signature, and my child’s signature, agreeing to this contract appear below.*

I agree

Signature of Parent or Guardian*

Date

Signature of Camper

Date

Is it agreeable for us to use any photos in which your child may appear?

Yes
No

Comments

This field is for validation purposes and should be left unchanged.