2021 Summer Day Camp Registration Please check one First Time Camper Returning Camper * Please note that 2022 registrations start Mid-December *Please check one Day Camp Overnight NB – Your child’s personal information is confidential and will only be made available to those who are deemed necessary i.e., specific camp personnel such as a first aider. Camper's Name First Last Sex Male Female Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail Date of Birth MM slash DD slash YYYY Health Card # Version USA Insurance Last grade completed as of June 30, 2022 Parent/GuardianParent/Guardian #1 First Last Home PhoneWork PhoneCell PhoneEmail Parent/Guardian #2 First Last Home PhoneWork PhoneCell PhoneEmail If parent or guardian not available, in case of emergency, please contactName First Last Relationship Home PhoneWork PhoneCell PhoneI would like to register for the following week July 3 – July 8 (13 – 17 yr olds) July 10 - July 15 (11-13 yr olds) July 17 - July 22 (11-13 yr olds) July 24 - July 29 (8 - 15) July 31 - Aug. 5 (8 - 15) Aug. 7 - Aug. 12 (8 - 15) Aug. 14 - Aug. 19 (8 - 15) Aug. 21 - Aug. 26 (8-15) How did you first hear about Rocky Ridge Ranch? Family Friend School Church Internet Guides/Scouts, etc. Advertisement Other CommentsMedical InformationHas the camper been exposed to any communicable diseases within the 3 weeks prior to camp attendance? Yes No Please check all current immunizations and provide the date of the last immunization: Diphtheria/Tetanus Date MM slash DD slash YYYY MMR – Measles/Mumps/Rubella Date MM slash DD slash YYYY Polio Date MM slash DD slash YYYY HBV – Hepatitis B Date MM slash DD slash YYYY Name of Family Physician First Last Phone of Family PhysicianPlease check if the camper has or has had any of the following Asthma ADD/ADHD Anxiety Appendicitis Bed-wetting Chicken Pox Diabetes Eating Disorder Epilepsy/fainting Frequent Colds Frequent Ear Infections Hay Fever Head Aches Heart Condition Hepatitis Lactose Intolerant Measles Mumps Nosebleeds Severe stomach aches Rheumatic Fever Sinusitis Sleepwalking Toothache Tonsillitis Whooping Cough Other If Other, please specifyAllergiesMedicationFoodInsect StingsCarry an Epipen? Yes No If other, please specifySpecial medication, dosage and when it should be taken. Please ensure all medication is in the original container. Prescription drugs MUST be in the original pharmacy container.Identify requirements for Special Care while at Camp. List: Medication and Dosage, Treatments.Daily ScheduleWeekly: Please specify dayOther : Please specifyReason for TreatmentSpecial diet (ie: lactose intolerant, vegetarian, etc.)Camper may participate in: Swimming Physical activity OPTIONAL CONTRIBUTION The Ranch is an officially registered Charity. Would you consider supporting our Camper Scholarship fund, Volunteer Summer Staff Scholarship (help for college/university tuition)?Amount ($) (TAX DEDUCTIBLE Registered # 119122273) We do not charge for minor medical attention performed by Camp staff. In the case of serious accident or illness, the services of a hospital, physician, dentist or any other related service (i.e., EMS) will be acquired and the charges will be made to the camper’s parents/guardians. Every reasonable attempt will be made to contact parents/guardians prior to services, wherever possible. We will make every effort to ensure that your child does not have a food allergy reaction while at Rocky Ridge. We are not a peanut-free location (although all known peanut products are removed from our kitchen). Our goal is to help your child self-manage his/her condition. Pricing Full Registration Fees Regular Camp – 1 child, 1 family - $660.00 Family Rate - more than 1 child in the same family - $640.00 Regular & Junior (5 – 7 year olds) Day Camp - $465.00 (Mon. – Fri.) Hockey Camp – residential - $890.00 - (IF ENOUGH ENROLLMENT) Hockey Day Camp - $615.00 (Mon. – Fri.) - (IF ENOUGH ENROLLMENT) Hockey Camp – “Ice Only” - $360.00 (Mon. – Fri.) - (IF ENOUGH ENROLLMENT) Deposit Fees $150.00 per Ranch Camper Week with Registration Form $100.00 per ALL Day Camper Weeks with Registration Form $250.00 Hockey Camp with Registration Form Balance due 1 week before camp arrival Balance due BEFORE camp arrival Specials and Extra Fees Register before March 1st and receive a free T-shirt.More than 1 child in the same family save $20.00per child.Stay an additional week(s) save 10% off the regular camp price.Fill a cabin with 5 or more new campers and your week is FREE! Waldo Photos–1 Week Session: $9.99 +$5 for each additional week;Day Camp:$4.99-photos taken thru the week and sent to your mobile phone–separate details upon registration. Horsemanship / Swimming Clinic Fees-$40.00 Pre-order Ranch Clothing – ONLY before May 31, 2022. Prices increase after May 31. Pre-order Ranch Clothing - before May 31, 2021 Adult S Adult M Adult L Adult XXL Adult XXL Ranch T-shirt - $20.00 Ranch Hat - $22.00 Ranch Hoodie - $50.00 Conditions of Registrations By signing this application, the parent/guardian certifies and agrees that: Medical Information: I certify that this camper is in good health and/or has been seen by a physician prior to attending this present camp week. Rocky Ridge Ranch may, if it considers it necessary, obtain and approve any emergency medical attention which may be reasonably necessary to the applicant camper’s welfare and good health or arrange for any special services or other requirements which it considers to be in the best interests of the applicant camper. The parent or guardian agrees to pay for any and all such services or requirements which have been utilized. Every reasonable attempt will be made to contact parents/guardians prior to services, wherever possible. Liability: While Rocky Ridge Ranch is dedicated to ensuring that every precaution is taken to safeguard the welfare of each applicant camper it is understood that there are certain activities that involve an inherent higher degree of risk. These risks of participation can be significantly reduced by carefully following instructions at all times. I acknowledge, freely accept and fully assume, on my behalf and on behalf of my camper (child), all risks, dangers and hazards of the Camp Activities, whether those risks are inherent or not, including the possibility of personal injury, including death, or property damage and any resulting loss. Rocky Ridge Ranch, its officers, directors, agents and employees (“Releasees”) cannot be held responsible therefore and are hereby released from any and all claims (or future claims) and liability for damages or accidental harm which may occur to the applicant camper or his or her property. Dismissal/Behaviour: Rocky Ridge Ranch’s Camp Director reserves the right to dismiss a camper who in his opinion is a hazard to the safety, rights and well-being of others and who has rejected the reasonable rules and controls of the Ranch. No refund will be issued. I agree to reimburse Rocky Ridge Ranch for any willful or intentional damage to property. Promotional Photos: I give the staff of Rocky Ridge Ranch permission to photograph/video the applicant camper while in attendance at Rocky Ridge Ranch for use in promotional materials which includes but is not limited to website, brochure, postcards, Facebook and other print, digital or electronic media. Lost Items: Rocky Ridge Ranch is not responsible for any personal belongings that are lost, stolen or damaged. Found articles of clothing are collected at the end of each week and held until claimed or at the end of September are donated to a charitable organization. Cancellation Policy: A deposit fee of $150.00 (Can.) per camper per week is required with the application form. (Day Camp-$100.00 /HockeyCamp-$250.00). The deposit is non-refundable after May 15. Prior to May 15 there is a cancellation fee of $50.00. There is a $30.00 charge for NSF cheques. Balance owing must be paid no later than 1 WEEK BEFORE camp arrival and is non-refundable. No refund will be made for late arrival, early departure or dismissal due to disciplinary action. In the case of early withdrawal for medical reasons, refunds will be provided on a prorated basis, less the $150.00 non-refundable deposit upon receipt of a signed doctor’s letter and as determined by the Director. I confirm that I am the parent or legal guardian of the applicant camper. If there are any conditions of custody, I will ensure that Rocky Ridge Ranch has written confirmation (photocopy of the appropriate section of the legal document) of the visitation rights. I have read and understand all of the above information and I agree to be bound by the terms. I am aware that I am waiving any legal rights by agreeing to sign below re the waiver of liability and medical release. I confirm that all the information supplied on this form is complete and correct. I give consent for the Ranch first-aid staff to administer to my camper non-prescription medication such as Tylenol, Advil, antihistamines, Gravol, cough medicine, etc., if the need arises. I give consent for the Ranch first-aid staff to obtain and approve any emergency medical attention, which may reasonably appear necessary to my camper’s welfare and good health. Rocky Ridge Ranch Inc. is seeking your consent to continue to receive valuable information about us, events like Open House, newsletters, etc., by email. Your signature confirms that you agree to have your name on our email list. You can unsubscribe at any time. Please ensure that you have read the Conditions for Registration above. You will be required to sign the form at the Registration Desk when you bring your child to camp.CAPTCHA