Reborn Ranch Camp
Register Today! (Current Age)
CAMPER INFORMATION
Camper's Name
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Camper's First Name
Camper's Last Name
Nickname
If your camper goes by a different name
Gender
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Female
Male
Campers current age
*
Campers Birthday
*
-
Month
-
Day
Year
Date
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PARENT/GUARDIAN INFORMATION
Parent or Guardian Name
*
First Name
Last Name
Mailing Address IF DIFFERENT FROM ABOVE ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Relationship to Camper
*
Emergency Contact
*
First and Last name
Emergency Contact Phone number
*
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Camp INFORMATION
Please select which camp your camper is signing up for if you have questions about camp, please email us at rebornranchhampton@gmail.com or call our office Tuesday-Friday 8am-1pm
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Youth Gals Camp Ages 11-13 June 9th-14th (girls)
Youth Gals Camp Ages 13-16 June 16th-26th (girls)
Youth Guys Camp Ages 11-13 June 30th-July 5th (boys)
Youth Guys Camp Ages 13-16 July 7th-July 17th (boys)
Dietary Needs
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No food allergy
Yes food allergy
If your camper has an allergy please describe below
Does your camper take any medications? Describe what and how often it is needed. (all meds need to be checked into an adult staff at check in)
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Is there any behaviors, physical limitations or anything else we should be aware of about your camper?
Can your camper swim (swimsuits for girls and boys need to be shorts and t-shirts) The Ranch has a laundry facility when needed.
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Yes, strong swimmer
Yes, but not a strong swimmer
No
Family Doctor & Clinic
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Name, Address, Phone number
Who is authorized to pick-up or visit your child at camp?
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Please enter first and last names of people who are able or will be picking your child up.
Is there anyone unable to pick-up or visit your camper?
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Please list their first and last names
Check each box that applies to previous Camps your camper attended.
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Reborn Ranch Camps
Other Camps
Never attended Camp
Does your camper have any experience with horses? Please note: Your camper does NOT need any prior experience with horses to attend camp, we just like to know levels of experience so we can asign the right horse and instruction during camp.
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None
A little
Beginner
Experienced
Expert/Advanced
How did you here about our camps?
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Facebook? Radio? Instagram? A friend? Family? A camper who attended previous years? Newspaper?
Check box if your give permission OR not
I give permission for camp staff to seek emergency medical treatment for my child if needed.
I give permission for my child to be photographed or recorded for Reborn Ranch promotional materials for social media and/or church presentations
I DO NOT give permission for camp staff to seek emergency medical treatment for my child if needed.
I DO NOT give permission for my child to be photographed or recorded for Reborn Ranch promotional materials for social media and/or church presentations
Is there anything else you would like for us to know about your camper?
Upload your health insurance picture here
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Upload a picture of your camper here
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Check which way is best to reach out with questions about your camper or any further questions we may have?
By Email
Phone Call
Submit
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