2023 Junior High Camp 2 Registration

Junior High Camp 2 Registration

July 10-15, 2023 Registration Deadline: Thursday, June 1, 2023
Please fill out individual registration forms for each camper. If you wish to pay with a check, please instead fill out the paper registration form that can be found on our website and mail that form to camp along with your check. Paper registrations must be postmarked by the deadline date of Thursday, June 1, 2023.
Camper Information
Camper's Name*

First NameLast Name
Gender*

MaleFemale
Birth Date*

MonthDayYear
Date
Grade camper will have completed by June 1, 2023*
Is this your first time at Trail Ridge?*

YesNo
If so, how did you hear about camp?
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please add me to the Mailbox Club and send me my first lesson!*

Yes, PleaseNo, Thanks
Campers will be receiving their first Keys for Kids booklet and completing the first week here at camp. These booklets are completely free and are sent out on a quarterly basis.*

Yes, I would like my child to start receiving Keys for Kids on a quarterly basis.No thank you, please do not send additional Keys for Kids materials.
Cabin Mate Request
Church Name and Location
Contact Information
Parent or Legal Guardian's Email Address*
example@example.com
Mother or Legal Guardian's Name*

First NameLast Name
Mother or Legal Guardian's Phone Number*

Area CodePhone Number
Father or Legal Guardian's Name*

First NameLast Name
Father or Legal Guardian's Phone Number*

Area CodePhone Number
Emergency Contact*

First NameLast NameRelation to Camper
Emergency Contact Phone Number*

Area CodePhone Number
Who will be picking up your camper on Saturday? (These will be the ONLY people we will release your camper to.)
Pickup Driver 1 *

First NameLast Name
Pickup Driver 1 Phone Number*

Area CodePhone Number
Pickup Driver 2 (optional)

First NameLast Name
Pickup Driver 2 Phone Number

Area CodePhone Number
Medical Information
Medical Conditions:*
Allergies (please describe allergy and reaction):*
Treatments for allergies listed above:
Dietary Restrictions (for medical reasons only)
Specific activities to be restricted (for medical reasons only)
Health Insurance Company*
Insurance Policy Number*
Subscriber Name*

First NameLast Name

Prescription medications, dosage, and schedule*

	Medication Name	Dosage	Administration Times
Medication 1
Medication 2
Medication 3
Medication 4

If certain over-the-counter medications are to be restricted, please list below:
Agreement

Please read the following agreement thoroughly before signing.
In consideration of Camper being allowed to attend Trail Ridge Camp Inc. (“Camp”) and participate in Camp programming and activities, Parent/Guardian agrees:
I. AUTHORITY AND RESPONSIBILITY FOR CAMPER
I understand, represent, warrant and agree that:
Camper is a minor child who may not be legally capable of binding him or herself under this Agreement
I have legal care, custody, and control of and for Camper and his or her parent or legal guardian.
I release and indemnify Camp, its agents and employees and any others associated with the camp from any and all claims and liability to or in relation Camper for any damages or injuries which may be sustained by Camper resulting from the Camp’s reliance on my authority and representations provided in the Medical Authorization, Media Authorization or other provision of this agreement.
II. MEDICAL AUTHORIZATION
I am authorized to release and provide Camper’s health information and history.
Camper’s health information and history provided on Camper’s Health Form is correct and accurately reflects Camper’s health history and current condition.
Unless specifically noted on the Health Form, Camper is in good health and able to participate in all camp activities.
In event of emergency or urgent situation, Camp is authorized to obtain and transport Camper for care to the Camp Physician or other emergency care provider. I further authorize the Camp Physician or such provider to hospitalize, secure proper treatment, and order injection, anesthesia, or surgery for the Camper, including x-rays and routine and emergency tests and examinations.
Routine Care: Camp is authorized to administer over-the-counter treatments for common conditions. Dosages will be administered according to directions on the bottle unless directed otherwise.
III. MEDIA AUTHORIZATION
Camp is authorized to create and use Camper’s likeness, actions, statements in any live or recorded audio, video, photographic, or other medium of display, transmission, exhibition, publication or reproduction of Camper present at or participating in any Camp location, programming or activity (“Camper Media”).
Camper Media shall be only for Camp purposes, programming and activities including, without limitation, for maintaining internal records and documentation and for advertising, marketing and other communications.
Camp’s use of Camper Media as authorized shall not constitute an invasion or breach of Camper privacy.
Parent or Legal Guardian's Signature

Clear
Scholarship Request
We know many families have been hit with financial hardships during the last couple of years. We do not want a financial situation to prevent you from sending your camper(s) to Trail Ridge this summer. Over the years, many have given to camp with your financial needs in mind. If you are in need of financial assistance, please do not hesitate to indicate your need of a scholarship for your family this summer.

Yes, we are in need of assistance with this year's registration fees.
Please give a brief description of the financial situation that creates the need for a scholarship for your family this year. This information will remain confidential. A Trail Ridge staff member will review your request and be in contact with you.
Registration Payment
When ordering a T-shirt, please consider future growth of your camper. The T-shirt size you order will be the size you receive. No exchanges will be made.*

I have read this and understand that no exchanges will be made for pre-ordered t-shirts.
Products*
prevnext( X )
Camper Registration$100.00
If this camper is attending an additional week of camp, please select the appropriate week under the "Attending Tab"

GenderAttending

"Topsy Turvy" Theme T-shirt$15.00

Size

Camper Photo Package$7.00
2 5x7 prints - large group photo, cabin group photo

I've requested to be contacted regarding financial assistance for camp this summer. (Please deselect all product boxes above before submitting) $ Free

Donation to Camp$1.00

Amount you wish to donate

Total $0.00
Should be Empty:

Junior High Camp 2 Registration

Camper Information

Contact Information

Medical Information

Agreement

Scholarship Request

Registration Payment