2022 Camp Rocky Registration

General Information
**Camp Registration is Full**

All of our cabins are now full.

By continuing to apply below, you are joining the waitlist for camp registration, and a place at camp is not garaunteed.
Camper Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Camper Phone
Please enter a valid phone number.
Camper Email
example@example.com
Date of Birth *

Month Day Year
Date
T-Shirt Size *
Sex
School Name
School Location
Grade Fall 2022
Parent/Guardian 1 Name *
Relationship to Camper
Parent/Guardian 1 Cell
Please enter a valid phone number.
Parent/Guardian 1 Work
Please enter a valid phone number.
Parent/Guardian 1 Home
Please enter a valid phone number.
Parent/Guardian Email *
example@example.com
Parent/Guardian 2 Name
Parent/Guardian 2 Cell
Please enter a valid phone number.
Parent/Guardian 2 Work
Please enter a valid phone number.
Other Emergency Contact Name
Other Emergency Contact Phone
Please enter a valid phone number.
Other Contact Relationship to Camper
Questions/Concerns
Parents: Please share with us any concerns/questions you may have for your child attending camp that would help us make their experience more enjoyable.
Age
CampDate

Month Day Year
Date
Conservation District
If you aren't sure, find your local conservation district at https://www.coloradoacd.org/conservation-districts.html
To save your progress and return later, click "Save" below. To continue, click "Next".

To be completed by camper:
In what groups, organizations or activities have you or do you participate? Identify any leadership positions held. *
What do you consider your greatest accomplishment to date? *
Explain why you are interested in attending Camp Rocky and what do you hope to gain from this experience? *
Describe a natural resource issue that is important to you. *
If you have previously attended Camp Rocky, which resource area did you participate in?
2022 Natural Resource Group Preferences:

Please indicate your 1st, 2nd and 3rd preferences. We will try to assign campers their first choice, based on application date, previous participation, and availability of discipline area.
First Choice *
Second Choice *
Third Choice *
THIS IS A RELEASE OF LIABILITY.
BY SIGNING BELOW, I AM AGREEING TO RELEASE CAMP ROCKY STAFF AND VOLUNTEERS, COLORADO ASSOCIATION OF CONSERVATION DISTRICTS DIRECTORS, STAFF AND MEMBERS, COLORADO STATE UNIVERSITY DIRECTORS, STAFF AND VOLUNTEERS, ROCKY MOUNTAIN MENNONITE CAMP STAFF AND DIRECTORS, ALL PARTICIPATING CONSERVATION PARTNERS AND ALL SPONSORS AND SCHOLARSHIP PROVIDERS FROM LIABILITY.

Introduction: I understand and acknowledge that participation in Camp Rocky is a privilege. In consideration of this privilege, I hereby enter into this Release of Liability (the "Release"). I understand that the Release applies to all activities associated with my participation in the Camp Rocky program.

Assumption of Risk and Acknowledgement of Understanding: I understand that during my camp session, I may participate in several activities including, but not limited to, archery, water activities, hiking, outdoor living skills, ropes courses, rock climbing. management of livestock (specifically llamas) and other strenuous activities requiring physical exertion. All of these activities may require me to assist and depend on the assistance of other participants in my assigned group. Although not desiring to discourage me from participating, Camp Rocky intends to make me aware that participation in these Camp activities exposes me to certain risks, including, by way of example, the risk of personal injury, and exposure to adverse weather conditions in mountainous areas. By signing this Release, I expressly assume these risks, whether such risks are known or unknown to me.

Release and Indemnification: In consideration for the privilege of participating in Camp Rocky, I hereby release and hold harmless CAMP ROCKY STAFF AND VOLUNTEERS, COLORADO ASSOCIATION OF CONSERVATION DISTRICTS, DIRECTORS, STAFF AND MEMBERS, COLORADO STATE UNIVERSITY DIRECTORS, STAFF AND VOLUNTEERS, ROCKY MOUNTAIN MENNONITE CAMP STAFF AND DIRECTORS, ALL PARTICIPATING CONSERVATION PARTNERS AND ALL SPONSORS AND SCHOLARSHIP PROVIDERS (collectively, the "Released Parties"), from, and to discharge and waive, any and all claims, demands, losses, damages, and liabilities with respect to any and all property damage, personal injury, and/or loss of life, arising from my participation in Camp Rocky. The foregoing sentence shall apply (without limitation) to all claims, demands, losses, damages, and liabilities described therein, whether known or unknown, foreseen, or unforeseen, future or contingent, except claims, demands, losses, damages, and liabilities arising out of the sole and exclusive gross negligence or willful and wanton misconduct of one or more of the
Released Parties. I covenant not to sue any of the Released Parties in connection with any of the claims, demands, losses, damages, and liabilities described above. The covenants and undertakings of this Release shall be binding upon me, my family, my heirs, next of kin, legal representatives, beneficiaries, successors, and assigns.

Miscellaneous: In the event that any provision of this Release is determined to be invalid for any reason, such invalidity shall not affect the validity of any of the other provisions, which other provisions shall remain in full force and effect as if this release had been executed with the invalid provision eliminated. I understand and agree that this Release is intended to be as broad and inclusive as permitted under applicable law.

I HAVE CAREFULLY READ THIS RELEASE OF LIABILITY. I ATTEST THAT I AM OVER EIGHTEEN (18) YEARS OF AGE AND AM NOT A MINOR IN MY STATE OF RESIDENCE OR, IF I AM A MINOR IN SUCH STATE, THAT MY PARENTS OR LEGAL GUARDIAN HAVE ALSO SIGNED THIS FORM BELOW.
Code of Conduct

I have read and agree to the Camp Rocky Code of Conduct found here.
Camper Signature *

Clear
Date *

Month Day Year
To save your progress and return later, click "Save" below. To continue, click "Next".

Health, Medical, & Emergency Information
Does your camper have any allergies? *
Allergy Information
Please describe allergy in detail, including sensitivity and typical reaction
Primary Care Provider *
Physician, PA, NP, etc.
Primary Care Provider Phone
Please enter a valid phone number.
Primary Care Provider Address or City/Town
Is anyone other than the individual above authorized to pick up your camper?
Pickup Name
Pickup Phone
Please enter a valid phone number.
Over the Counter Medication: May the following over the counter (OTC) medications be given to your child as needed while at camp, under the supervision of a camp nurse, EMT, or other state-licensed practitioner?

OTC Medications *

	Allowed?
Acetominophen (Tylenol)
Aloe Vera (sunburn)
Antihistamine (Benadryl)
Bacitracine ointment (antibiotic cream)
Carmex or Vaseline (chapped skin)
Claritin (for sneezing, itching, watery eyes)
Ibuprofen (Advil)
Maalox (for abdominal pain)
Metamucil (for constipation)
Milk of Magnesia (for constipation)
Mylanta (for abdominal pain)
Saline solution (for eye irrigation)
Sunscreen (Banana Boat SPF 50)
Throat lozenges
Tums (indigestion)
Zantac 75 (for heartburn/indigestion
Zyrtec (For sneezing, itching, watery eyes

Is there anything the camp needs to be aware of when giving any of the approved OTC meds to your child?
• The program agrees to administer medication prescribe by a licensed health care provider.
• It is the parent/guardian’s responsibility to furnish this prescription medication.
• The parent agrees to pick up expired or unused medication within one week notification by staff.
• Prescription medications must come in the original container labeled with: child’s name, name of medicine, time medicine to be given, dosage, and date medicine is to be stopped and Licensed health care provider’s name. Pharmacy name and phone number must also be included on the label.
Emergency Treatment: In case of emergency, I understand that every effort will be made to contact one or more of the methods listed on this document. If it is not possible to locate any of these emergency contacts, I hereby give permission to camp officials to call a doctor or emergency medical service to assist and for said doctor or medical service to provide emergency medical or surgical for this child.
I hereby give permission for my child to participate in all camp activities, including outings and excursions where campers will be hiking or riding in a vehicle away from camp premises, with *
Exceptions:
Please describe any activity limitations
Does your camper take any medications? *
Name and Dosage
Time of Day

THIS IS A RELEASE OF LIABILITY.
BY SIGNING BELOW, I AM AGREEING TO RELEASE CAMP ROCKY STAFF AND VOLUNTEERS, COLORADO ASSOCIATION OF CONSERVATION DISTRICTS DIRECTORS, STAFF AND MEMBERS, COLORADO STATE UNIVERSITY DIRECTORS, STAFF AND VOLUNTEERS, ROCKY MOUNTAIN MENNONITE CAMP STAFF AND DIRECTORS, ALL PARTICIPATING CONSERVATION PARTNERS AND ALL SPONSORS AND SCHOLARSHIP PROVIDERS FROM LIABILITY.

Introduction: I understand and acknowledge that participation in Camp Rocky is a privilege. In consideration of this privilege, I hereby enter into this Release of Liability (the "Release"). I understand that the Release applies to all activities associated with my participation in the Camp Rocky program.

Assumption of Risk and Acknowledgement of Understanding: I understand that during my camp session, I may participate in several activities including, but not limited to, archery, water activities, hiking, outdoor living skills, ropes courses, rock climbing. management of livestock (specifically llamas) and other strenuous activities requiring physical exertion. All of these activities may require me to assist and depend on the assistance of other participants in my assigned group. Although not desiring to discourage me from participating, Camp Rocky intends to make me aware that participation in these Camp activities exposes me to certain risks, including, by way of example, the risk of personal injury, and exposure to adverse weather conditions in mountainous areas. By signing this Release, I expressly assume these risks, whether such risks are known or unknown to me.

Release and Indemnification: In consideration for the privilege of participating in Camp Rocky, I hereby release and hold harmless CAMP ROCKY STAFF AND VOLUNTEERS, COLORADO ASSOCIATION OF CONSERVATION DISTRICTS, DIRECTORS, STAFF AND MEMBERS, COLORADO STATE UNIVERSITY DIRECTORS, STAFF AND VOLUNTEERS, ROCKY MOUNTAIN MENNONITE CAMP STAFF AND DIRECTORS, ALL PARTICIPATING CONSERVATION PARTNERS AND ALL SPONSORS AND SCHOLARSHIP PROVIDERS (collectively, the "Released Parties"), from, and to discharge and waive, any and all claims, demands, losses, damages, and liabilities with respect to any and all property damage, personal injury, and/or loss of life, arising from my participation in Camp Rocky. The foregoing sentence shall apply (without limitation) to all claims, demands, losses, damages, and liabilities described therein, whether known or unknown, foreseen, or unforeseen, future or contingent, except claims, demands, losses, damages, and liabilities arising out of the sole and exclusive gross negligence or willful and wanton misconduct of one or more of the
Released Parties. I covenant not to sue any of the Released Parties in connection with any of the claims, demands, losses, damages, and liabilities described above. The covenants and undertakings of this Release shall be binding upon me, my family, my heirs, next of kin, legal representatives, beneficiaries, successors, and assigns.

Miscellaneous: In the event that any provision of this Release is determined to be invalid for any reason, such invalidity shall not affect the validity of any of the other provisions, which other provisions shall remain in full force and effect as if this release had been executed with the invalid provision eliminated. I understand and agree that this Release is intended to be as broad and inclusive as permitted under applicable law.

I HAVE CAREFULLY READ THIS RELEASE OF LIABILITY. I ATTEST THAT I AM OVER EIGHTEEN (18) YEARS OF AGE AND AM NOT A MINOR IN MY STATE OF RESIDENCE OR, IF I AM A MINOR IN SUCH STATE, THAT MY PARENTS OR LEGAL GUARDIAN HAVE ALSO SIGNED THIS FORM BELOW.
Photos/Media: Permission is hereby given for Camp Rocky and the Rocky Mountain Mennonite Camp to use any pictures in which my child appears for publicity purposes. A private cloud account may be used for photo sharing within our group
Code of Conduct

I have read and discussed the Camp Rocky Code of Conduct found here with my camper. I understand that violation of the Code of Conduct may result in disciplinary action, up to and including expulsion without refund.
Parent Signature *

Clear

Payment Information
In many instances, scholarships to cover all or part of the cost of camp attendance are available from your local conservation district. To locate your local district, visit this map. If you are interested in a scholarship but have not yet been in contact with your local Conservation District, contact Bobbi Ketels at bobbi@coloradoacd.org

If you know you have a fully-covered scholarship assigned, no payment is required today.

If you are currently seeking a scholarship, a $100 deposit is required at the time of registration.

You may also elect to pay the entire $350 fee here.
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General Information

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Health, Medical, & Emergency Information

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