2024 Loving Hands Ranch Camper Registration

Loving Hands Ranch Camper Registration

The form will need to be filled out in it's entirety prior to camp start. Any further questions can be directed to info@lovinghandsranch.org. This year’s camps (2024) will be held at Cornerstone Kids Ranch in Ada, OK. 11960 County Rd 3536, Ada, OK 74820. Drop off at 6:00 pm on Thursday, pickup at 11:00 am on Sunday.
Your email:*
example@example.com
Camper name:*

First NameLast Name
Camper Date of Birth*

MonthDayYear
Date
Camper grade (going into this Fall): *
Camper age:*
MaleFemale
Deaf Teens, June 13-16, going into 7th grade through HS graduationDeaf Kids, June 20-23, ages 6 through going into 6th gradeDeaf Unique Needs, June 20-23, ages 6 and upCODA (Child of Deaf Adult), June 27-30, ages 6 through HS graduation
Please select a t-shirt size*
Second Camper (if applicable):
Third Camper (if applicable):
Fourth Camper (if applicable):
Parent/guardian phone number:*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your camper/campers have any known allergies, medication, or medical conditions? Please describe below. If your camper(s) takes medication please list time and dosage. *
Is your camper Deaf or Hard of Hearing? Does your camper wear a hearing device/hearing amplification of any kind? If yes, please list below: *
Credit Card in this form (linked below)Cash at start of campMy camper needs a scholarship pleaseI can make a partial paymentI will mail in a check to Loving Hands Ranch at PO Box 928 Sulphur, OK 73086
Emergency contact information

This person will be contacted if parent/guardian cannot be reached in the event of an emergency.
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Email
example@example.com

Camp payment

Camp Registration for 1

$150.00 Quantity

Camp Registration for 2 campers

$225.00

Camp Registration for 3 campers

$300.00

Camp Registration for 4 campers

$375.00

Snack Bar advanced payment in increments of $5

$5.00 Quantity

Camp donation in increments of $10

$10.00 Quantity

Partial Payment in increments of $10, remaining balance due at time of camp

$10.00 Quantity

Total

$0.00

Credit Card

Consent for photo release:

I hereby grant permission to Loving Hands Ranch to use photographs and/or video of my camper/campers taken during camp(s) in publications, news releases, online, and in other communications related to the mission of Loving Hands Ranch.
I agree to photo releaseI do not agree to photo release
Informed Consent and Acknowledgement

I hereby give my approval, as parent/guardian to camper(s) listed above, for participation in any and all activities prepared by Loving Hands Ranch (LHR) during the selected camp. In exchange for the acceptance of camper candidacy at Loving Hands Ranch (LHR), I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless LHR, and all its respective officers, agents, and representatives from any and all liability for injuries arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said camper(s), I hereby waive all claims against LHR including all staff, volunteers, entities, all participants, owners and lessors of camp premises used to conduct the events. There is a risk of being injured that is inherent in various activities.

Loving Hands Ranch is not responsible for lost, damaged, or stolen items/belongings including, but not limited to, hearing devices/amplification, medical devices, personal items, and other.
Initial here to acknowledge you've read the above statement:*
Medical Release and Authorization

As the parent/legal guardian of named camper(s), I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the named camper(s), in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the camper's life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper(s). In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact the listed emergency contact person in the most expeditious way possible.

Permission is also granted to Loving Hands Ranch and its affiliates including Directors, volunteers, and other known affiliates to provide the needed emergency treatment prior to admission to the medical facility.

Release authorized on the dates and/or duration of the registered camp sessions.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named camper(s).
Initial here to acknowledge you've read the above statement:*
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*

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