2022 Camper Application

2022 Camper Application

Due to the way the application is set up, it must be completed in one sitting. Thank you! Please know that due to numbers, Campers may only attend 2x.
Camper name:

First NameLast Name
Nickname (for name tag)
Camper date of birth:
00/00/0000
Camper sex:

FemaleMale
Camper age at Camp Comfort
Camper grade 2022-2023 school year:
Camp interest: As of 5/25 Both camps are on a wait list and we have had to close it. Please email swandling@mtevans and we will send you resources to assist you with resources for children's grief. We are so sorry to not be able to assist you this year.

June 17-19, 2022July 15-17, 2022
Guardian 1 information:

First NameLast Name
Relationship to child
Parent, Aunt, Uncle, Grandparent, other
Guardian 2 information:

First NameLast Name
Camper address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Guardian 1 Email
example@example.com
Guardian 2 Email
example@example.com
Guardian 1 phone number:

Area CodePhone Number
Guardian 2 phone number:

Area CodePhone Number
Emergency contact:
Does your child have any diet restrictions?
If you listed "yes" for diet restrictions, please explain below
Only needed if your child has a diet restriction
Camper T-Shirt Size
All Campers receive a free t-shirt on Friday night at camp.
How did you hear about Camp Comfort?
Please list name of organization or school
If your camper has attended camp before, what year(s)? We are sorry but Campers may only attend Camp Comfort 2x
Has your camper attended Camp Comfort before?

NoYes

Camp Comfort Releases:
The health history included in this packet is correct as far as I know, and the child herein described has my permission to participate in all prescribed camp I give permission to Mount Evans to share the information contained in this packet with the staff and volunteers who will be working with my child.

I give my permission to administer the above-noted medications or prescriptions and/or first aid to my child. I also give permission for the Camp Comfort/Mount Evans staff to obtain emergency medical care, including transportation for my child if I cannot be reached by telephone for consent. I agree not to send my child to Camp Comfort if he or she has been ill or exposed to a contagious disease and to notify Camp Comfort/Mount Evans if this situation arises.
Signature of Parent/ Guardian

Clear
Upon occasion videotaping and photography may occur during various camp activities. Mount Evans may use this material in future camp publicity. In addition, the news media may wish to photograph, videotape, and/or interview children for news coverage of Camp Comfort.
Photography Release:

Yes, I do give permission for my child to appear in publicity or news coverage in relationship to Camp Comfort as described above.No, I DO NOT give permission for my child to appear in publicity or news coverage in relationship to Camp Comfort as described above.
If someone other than the undersigned is to pick up my child at the end of the camp session, such person must present written authorization from the undersigned. I do hereby authorize the following to pick up my child:
Please include: Name, Relationship, & Contact Information
In consideration of my child's acceptance as a participant in Camp Comfort, I, for myself and my minor child, release and discharge Mount Evans Home Health Care & Hospice (referred to as, "Mount Evans"), its agents, employees, volunteers, officers and directors, from any and all claims demands, or actions which I or my child ever had, now have, or may in the future have against Mount Evans, its agents, employees, volunteers, officers or directors for all personal injuries, either physical or emotional, known or unknown and injury to property, real or personal, sustained by my child's person or property during his or her attendance at Camp Comfort unless such injury or damage is due to the negligence or intentional misconduct of Mount Evans, or one of its personnel listed above. I specifically release and discharge Mount Evans and all those listed above from any claim that it or they were negligent in the selection of Easter Seals Colorado – Rocky Mountain Village as the operators of the camp. I understand that outdoor activities carry with them certain associated risks including the risk of physical injury. I accept those risks, known and unknown, for myself and my child as part of the camping experience.
Parent/ Guardian Signature

Clear
The following activities require parent/guardian permission for your child to have the choice to participate. During free time at Camp Comfort, camper’s have the opportunity to choose from many activities. Often, these activities support children in taking safe risks in their grief journey. Challenge by choice is the philosophy around allow campers to choose the intensity, duration, and activities during free time!

Horse back riding (YES)Climbing wall/ zipline (YES)Swimming (Lifeguard on duty) (YES)Horseback riding (NO)Climbing wall/ zipline (NO)Swimming (Lifeguard on duty) (NO)

Payment FAQs:
- If you need to request a scholarship, please skip the payment form.
- If someone else is going to pay for your camper, please skip the payment form.
- If you have payment questions please email Sallie Wandling, Senior Camp Director at SWandling@mtevans.org

My Products

Camp Comfort Camper Registration 2022$25.00

This is a non-refundable deposit.

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Total $0.00

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2022 Camper Application

Bereavement History:

Health History:

Help us get to know your camper:

Camp Comfort Releases:

Credit Card