2023 Mother/Daughter Retreat Registration

Please note: your progress will not be saved if you exit the form without submitting and completing payment (if paying with credit card).

If you prefer to pay by check, continue filling out the form and select the box indicating that preference. Checks must be mailed and postmarked by the deadline date of Wednesday, April 26, 2023. Registration is not finalized until payment is received.

Total Number of Campers (including adults)*

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1
Camper 2

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1
Camper 2
Camper 3

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1
Camper 2
Camper 3
Camper 4

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1
Camper 2
Camper 3
Camper 4
Camper 5

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1
Camper 2
Camper 3
Camper 4
Camper 5
Camper 6

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1
Camper 2
Camper 3
Camper 4
Camper 5
Camper 6
Camper 7

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1
Camper 2
Camper 3
Camper 4
Camper 5
Camper 6
Camper 7
Camper 8

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1
Camper 2
Camper 3
Camper 4
Camper 5
Camper 6
Camper 7
Camper 8
Camper 9

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1
Camper 2
Camper 3
Camper 4
Camper 5
Camper 6
Camper 7
Camper 8
Camper 9
Camper 10

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1
Camper 2
Camper 3
Camper 4
Camper 5
Camper 6
Camper 7
Camper 8
Camper 9
Camper 10
Camper 11

Camper Names and Ages*

	First Name	Last Name	Age
Camper 1
Camper 2
Camper 3
Camper 4
Camper 5
Camper 6
Camper 7
Camper 8
Camper 9
Camper 10
Camper 11
Camper 12

Cabin Mate Requests (We will do our best to honor all cabin mate requests, but cannot guarantee our ability to do so.)

Your Church Name and Location

Is this your first time at Trail Ridge?*

YesNo

If so, how did you hear about camp?

Contact Person*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Area CodePhone Number

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Area CodePhone Number

Does anyone in your group have any medical conditions or physical limitations we should take into consideration?*

Does anyone in your group have any dietary restrictions due to allergies or other medical reasons? (Our kitchen staff will do their best to accommodate any reasonable requests.)*

In consideration of attending Trail Ridge Camp Inc. (“Camp”) and participate in Camp programming and activities, I ("Camper") agree:
I. AUTHORITY AND RESPONSIBILITY FOR CAMPER
I understand, represent, warrant and agree that:
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 to 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
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.
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.

Signature*

Clear

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 your family from attending Trail Ridge. 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.

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.

Please select the appropriate number of campers per age group.*

Adults (Ages 18+)$75.00

Quantity

Daughters (Ages 4-17)$50.00

Quantity

Little Ones (Ages 0-3) $ Free

Quantity

Donation to Camp$1.00

Your donation helps us provide camp opportunities for those in need.

Amount you wish to donate

Total $0.00

Select this box if you prefer to pay by check. Checks must be mailed and postmarked by the deadline date of Wednesday, April 26, 2023. Registration is not finalized until payment is received.

Pay by check

2023 Mother/Daughter Retreat Registration

Campers Information

Contact Information

Additional Information

Agreement

Scholarship Request

Registration Payment