2019 Blue Mountain Ranch Camper Application (must be filled out for each camper)

2019 Camper Application for Enrollment

Child's Photo

Upload a File

Please send a photo that is 2MB or less. Thank you!

This will be your child's ___ year at BMR? *

Child's Name *

First Name Middle Name Last Name

Nickname, if any

Nickname

Sex:

Birth Date *

Month Day Year

Age *

Height *

Weight in lbs. *

Name of School *

Grade *

Can your child swim? *

Can your child ride horses? *

Can your child play a musical instrument? *

If so, what instrument?

What are your child's hobbies/special interests? *

Check the activities you would like your child to experience at camp. *

Does your child have any special habits? *

What do you most desire your child to accomplish at camp? *

Personal Reference: *

List the name and phone number of an adult your child knows outside of school.

School Reference: *

List the name and phone number of an adult your child knows from school.

Mother's Name: *

First Name Last Name

Mother's Employer: *

Mother's Occupation: *

Mother's Home Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Work Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Home Phone *

- Area Code Phone Number

Mother's Work Phone: *

- Area Code Phone Number

Mother's Mobile: *

- Area Code Phone Number

Mother's E-mail: *

Father's Name: *

First Name Last Name

Father's Occupation: *

Father's Employer: *

Father's Home Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Father's Work Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Father's Home Phone

- Area Code Phone Number

Father's Work: *

- Area Code Phone Number

Father's Mobile: *

- Area Code Phone Number

Father's E-mail: *

Are parents divorced? *

If yes, please fill out custody form.

If divorced, list the name of the custodial parent.

If divorced, is the non-custodial parent allowed to visit/take child from camp?

Please inform camp of specifics before camper arrives.

Are either parents deceased? *

Where did you hear about Blue Mountain Ranch? *

If referred by a friend, please list friend's name so we can thank them.

Please list the names and ages of other children in the family: *

List the names & addresses of 3 friends you would like to recommend for camp:

I would like to register my child for the following camp sessions: (Check One) *

Session 1: June 8-June 23 (16 days) $2500 Session 2: June 25-July 19 (25 days) $3700 Session 3: July 21-August 5 (16 days) $2600 Combination of Two Sessions $5500 I will contact camp office to discuss possible dates.

Parent Acknowledgement: by checking the below terms and conditions, I agree and acknowledge that I have read all completely. *

Blue Mountain Ranch is not responsible for campers while they are traveling to and from camp. Blue Mountain Ranch is not responsible for loss of personal equipment by fire, theft, water damage, or carelessness of camper. The camp will provide every reasonable safeguard for the health and safety of each child. However, in the event of accident or illness, parents/guardians will pay all expenses. Parents/Guardians will be billed for any prescriptions or medicines required. In case of early departure due to illness or accident, loss of reminaing camp fee will be shared equally between camp and parents/guardians. Parents/Guardians should not take camper out of camp. Health, happiness, and personal accomplishments in camp are better for campers who do not leave camp, even with parents. No reduction will be made for late arrivals or early departures of terms enrolled for, regardless of reason. The value of the camping experience is minimized by either late arrival or early departure from the camp term. In signging this application, the parent/guardian certifies that the child is in good, normal health, has no abnormal tendencies, and would make a desirable companion for other children. It is understood that the Director reserves the right to refuse any applicant without stating reason, and to dismiss any camper whose influence is not good for our organization. The parent/guardian also gives permission for his/her child to participate in all camp activities, including field trips, as well as being photographed for the yearbook and website (names excluded) unless otherwise noted in writing to camp.

Signature of Parent/Guardian: *

Deposit Fee: *

I agree to pay a $250 deposit fee for EACH TERM attending to be credited toward the camp fee. I agree to pay the camp balance on or before May 1, 2019.

Pay deposit here:

USD $250 deposit per term

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Print Form for your records before you submit!

Child Information:

PARENT/GUARDIAN INFORMATION: