Camp Ridgedale Registration Form

Camp Ridgedale Summer 2023 Registration
Thanks for Registering with Camp Ridgedale!

It is our mission to provide your family with a safe and exciting camp experience that leads your campers to fall in love with the Gospel of Jesus Christ. Please complete the registration form in its entirety and pay the $60.00 registration fee to secure your child's summer of fun!
NOTE - Children need to have completed Kindergarten before they are eligible to participate in Elementary camp (Completion of K-5th).

Our CIT Program is available for students who have completed 6th grade-10th Grade. A Flat rate will be charged for participation of two weeks in the program. CIT's may serve additional weeks at cost of field trips and extended care if needed. Additional week fees will be invoiced following completion of two week program.

Standard camp hours will be from 8am-3pm, Extended care is avalible at a 30$ per week flat rate. Extended care is available with early drop off begining at 7:30am and afternoon care from 3:30pm - 5:45.

*Due to the limitations of our current facilities and staffing we are currently unable to accommodate campers with speical needs and or any major phsycial or behavioral limtations. For more information about programs in our area that can accomidate for such needs please contact us @communitykidsridgedale@gmail.com or (423-704-8203).
Camper's Information
Last Name*
First Name*
Middle Name*
Gender*

MaleFemale
Address*
City*
State*
Zip*
Birth Date*

MonthDayYear
Grade entering in the fall*
Which camp would your child like to attend

Elementary Standard ( 8am- 3pm)Elementary+ Extended Care (7:30am-5:45pm)CIT Program
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation*
Work Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Parent /Legal Guardian 2*
Relation 2*
Work Phone 2*

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Home Phone*

Area CodePhone Number
How would you like to be contacted while your child is at camp?

Work PhoneCell PhoneHome Phone
Emergency Contact Info

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Emergency Contact #1 Name*
Phone Number*

Area CodePhone Number
Relationship to Child*
Emergency Contact #2 Name*
Phone Number #2*

Area CodePhone Number
Relationship to Child*
Email Confirmation
Parents Email*
- Be certain to enter your email address correctly on the registration form to receive camper confirmation.
Other Information
How did you hear about Camp Ridgedale?
Campers Home Church?
T-Shirt Size?*
First Time Camper?*

YesNo
Any siblings attending camp?*

YesNo
Camper Swimming Ability

Non-SwimmerBeginner Swimmer (can swim on front 20ft without flotation)Advanced Swimmer (can pass swim test)
Health Information
Does your Child have health coverage?

YesNo
Name and Phone Number of Primary Care Physician
Are immunizations up to date?

YesNo
Date of last tetanus shot
Any activity the camper should be restricted from?
Any physical, mental or other condition that would require special attention or medication while at camp?
Please list all medications, both prescribed and over the counter. All medications will be turned into and distributed by Camp Administrative Staff. Rescue inhalers and/or epipens, topical ointments, and basic first-aid items will remain with and may be administered by Counselors/Cabin leaders. All medication MUST be in original containers.
List any allergies (ex: bees,pollen,peanuts, dairy)
Any dietary needs or restrictions?
Do your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?

YesNo
In the case of an emergency involving your child(ren), I give permission to Camp Ridgedale staff to provide and to obtain emergency medical treatment for my child(ren) and to act as their guardian in permitting medical treatment if unable to reach parent or legal guardian. I understand that all emergency and/or medical cost are the parent or legal guardian's financial responsibility.
I have read and agree to these terms*

Clear
* A medical form and distrbution wavier will be emailed follwing registarion and must be compleated and noterized piror to your childs first day of camp.
Behavior and Discipline Policy

At Camp Ridgedale bullying is inexcusable, and we have a firm policy against all types of bullying. Each camper is expected to treat all other campers with respect, and to help each other achieve the best possible experience.
If a camper has difficulty meeting this expectation, parents may be called upon to assist. Our leadership addresses all incidents of bullying seriously and trains staff to promote communication with their staff and their campers. We work together as a team to ensure that campers gain self-confidence, make new friends, and go home with a positive camp experience.

Physical violence or bullying towards a camper or staff will result in immediate dismissal from program. Examples of unacceptable behavior:

- Refusing to follow behavior guidelines or camp rules
- Using profanity, vulgarity or obscenity
- Stealing or damaging property (personal or camp property)
- Refusal to participate in activities or cooperate with staff
- Disrupting a program or leaving a program without permission
- Endangering the health and safety of children and/or staff
- Use of illicit drugs, alcohol or tobacco or sexual conduct of any kind
- Teasing, making fun or bullying of other campers or staff
- Fighting of any kind
- Horseplay at the pool

***Fees are non-refundable and child will be ineligible to re-enroll in Ridgedale Child Enrichment Program, including Community Kids and Camp Ridgedale if dismissed for any reason.
Are there any discipline or behavior issues that we need to be aware of ? Does your child hold a diagnosis that we need to be aware of? Has your child ever been dismissed from a program for behavior or discipline issues? If yes, please explain.
I have read and agree with the Discipline Policy *

Clear
Camper Photo Release
I give permission for my child to be photographed and/or videotaped by the staff of Camp Ridgedale and Ridgedale Baptist Church approved by the Director of the program. Content will be used for purposes of advertising, public relations, and family enrichment. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use*

YesNo
Signature*

Clear
Permission to Transport

Campers will participate in weekly field-trips, campers will be transported to trip locations in chartered transportation services.
I give permission for my child to travel by private transport for off campus activities. I understand that in order to provide transport, the driver must be the holder of a current driver’s license with proper endorsements and that vehicle(s) must be registered and covered by compulsory Third Party Insurance. *

YesNo
Signature*

Clear
Child Dismissal Release

List Below all those permitted to pick up your child from camp. All individuals must show present a valid photo ID and assigned pick up identification number in order to pick up your child. Persons may be added to pick up list during summer programing only with handwritten and confirmation from Camp Administrative Staff and Parental Guardians.
Please List Person(s) with permission to pick up your child from Camp.*
Please list any person(s) that may NOT under any circumstances be allowed to pick up your child.
Late Pick-Up

Extended Care hours end at 5:45, there will be a grace period ending at 6pm. Any Pick-up after 6pm will require a charge of $1 per minute. (6:15 pick-up will cost $15.00) * Excessive tardiness could result in your child's dismissal from the program.
I have read and agree with the listed Child Dismissal and Late Pick-Up policies and fees.*

Clear
Payment Information

$60 Non-refundable registration fee is required, this fee will go towards your overall balance for one week of camp. Weekly fees must be paid in full one week prior to each attending week. For example, all fees for May 31st-June 2nd must be paid in full by May 22nd. If you are registering multiple children, a discount code will be sent following your submission for your first camper, this code will be unique to you and may be used up to three times. There will be a 10% discount for our Full Summer or upfront option, this discount has already been applied and is reflected in the listed prices below.
Please select week(s) attending*

Jump Into Summer (May 31st- June 2nd) *Mini WeekMove It! (June 5th- June 9th)Treasure Hunters (June 12th- June 16th)Underwater World (June 19th- June 23rd)W!ld About Animals (June 26th- June 30th)The Mess Festival (July 5th-July 7th) *Mini WeekOut of this World (July 10th- July 14th)Center Stage (July 17th-21st)H2O Woah! (July 24th-28th)Super Awesome Summer (July 31st- Aug 4th)
Method of payment

Credit CardDebit Card

Camp Payment Options*

Registration Fee$60.00

Full Summer $1,037.00

Price reflects 10% discount.

Full Summer + Extended Care$1,282.00

Price reflects 10% discount.

Elementary Camp Standard $120.00

Number of weeks

Elementary Camp + After Care$150.00

Number of weeks

Elementary Camp Mini-Week $96.00

Number of weeks

Elementary Camp Mini- Week + Extended Care$112.00

Number of weeks

CIT Program $100.00

Enter coupon

Total $0.00

By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. The camp carries secondary insurance. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I understand and commit to payment of all camp fees ,I understand that I must pay a non-refundable registration fee, per child, at time of registration. I understand that I am financially responsible and agree to pay Camp Ridgedale for the weeks I have reserved for my child(ren), even if my child does not attend. If I find that I need to swap or drop weeks, I understand that this will be allowed on a space available basis only and I must submit proper documentation to be approved and I will only receive a 70% refund.
I certify that my child has my permission to attend camp and participate in all activites.
Signature

Clear
Initial and Date*
Should be Empty:

Camp Ridgedale Summer 2023 Registration

Thanks for Registering with Camp Ridgedale!

NOTE - Children need to have completed Kindergarten before they are eligible to participate in Elementary camp (Completion of K-5th).

Camper's Information

Parent or Legal Guardian Information

Emergency Contact Info

Email Confirmation

Other Information

Health Information

Behavior and Discipline Policy

Camper Photo Release

Permission to Transport

Child Dismissal Release

Late Pick-Up

Payment Information