Camp Registration – Lone Tree Ranch

Name

Relationship to Child

Address

Home Phone #

Cell Phone #

Child #1

Childs Name (First & Last)

Childs Date of Birth

Sex

Male Female

T-Shirt Size

Please list any Special conditions such as allergies, medications, disabilities, physical impairments/limitations, behavioral problems etc.

Child #2

Childs Name (First & Last)

Childs Date of Birth

Sex

Male Female

T-Shirt Size

Please list any Special conditions such as allergies, medications, disabilities, physical impairments/limitations, behavioral problems etc.

Child #3

Childs Name (First & Last)

Childs Date of Birth

Sex

Male Female

T-Shirt Size

Please list any Special conditions such as allergies, medications, disabilities, physical impairments/limitations, behavioral problems etc.

Please Read Carefully

AUTHORIZATION FOR PARTICIPATION IN CAMP ACTIVITIES
I hereby give my consent FOR MY CHILD TO PARTICIPATE IN ANY AND ALL ACTIVITIES AT Lone Tree Ranch Youth Camp. This may include, but is not limited to; church activities, horseback riding, hiking and similar events.

ALL campers and volunteers must have the liability waiver and registration paperwork completed PRIOR to participation in ANY camp activities;

There is never to be any 1:1 or leaders accompanying a single camper unless the two are nearby and are actively observed by camp staff;

Only APPROVED staff and volunteers to lead and assist with campers within the round pen or any enclosed space;

Only APPROVED attire is to be worn by staff, volunteers and campers;
** Closed toed shoes
** Long pants or jeans
** Fitted shirt (nothing to loose or baggy, nothing with a large front pocket or
long strings)
** No long necklaces, bracelets, lanyards, tethered badges

HELMETS MUST BE WORN BY ALL RIDERS AT ALL TIMES WHEN MOUNTED, NO EXCEPTIONS,

NO OPEN-TOED SHOES (TENNIS SHOES OK)

Camp Participation Authorization

I have read and accept the conditions.

AUTHORIZATION FOR MEDICAL TREATMENT
I hereby give my consent to any leader of Lone Tree Ranch Youth Camp, Inc., to (1) obtain or arrange for emergency treatment such as x-rays, anesthesia, medical, surgical, dental, mental, behavioral or psychiatric diagnosis or treatment and hospital care to be rendered to my child under the general or special supervision and advice of a medical practitioner licensed to practice in the State of Oregon; (2) Provide first aid and over the counter remedies and treatment to my child on the premises of the camp; (3) transfer my child to any hospital, clinic, or medical office reasonably accessible if necessary. This authorization covers major surgery only if the medical opinions of TWO (2) licensed physicians concur that such surgery is immediately necessary. I agree to release Lone Tree Ranch Youth Camp, Inc., from all financial liability for any expense that may be incurred in the event medical, as directed above, is needed. I agree to be responsible for all medical expenses incurred as described above. The above is in accordance with Oregon Liability Revised Statutes 30.689

Medical Treatment Authorization

I have read and accept the conditions.

WAIVER OF LIABILITY I hereby affirm that I am the parent or legal guardian of the minor child. I agree that I will not hold Lone Tree Ranch Youth Camp, Inc., liable or responsible for any injury to or property loss of my child due to an accident, neglect or recklessness by any person that occurs during or in connection with any activity at Lone Tree Ranch Youth Camp, Inc. I release Lone Tree Ranch youth Camp, Inc., and all its directors, officers, staff, employees and volunteers from any and all liability for any and all injuries which my child (children) may receive, and for any and all liability for any first aid or medical treatment provided or arranged. A photo copy of this authorization for medical care shall be valid as the original and shall remain in effect until revoked in writing. Lone Tree Ranch Youth Camp requires an authorization form for each minor child signed by the child’s parent or legal guardian before attending camp. No minor will be allowed on the premises unless this form is completed and provided to the camp office beforehand. NOTE: There is staff available at Lone Tree Ranch who has been trained to administer Epinephrine to someone who is having an anaphylactic reaction; however, no Epinephrine is available at Lone Tree Ranch. If you may need it, be sure to bring it with you.

Waiver of Liability

I have read and accept the conditions.

Date

Digital Signature

WE NEED YOUR HELP! Come help us get camp ready! Clean up days 9a-12p May 11 & June 15 Click for more information

Lone Tree Youth Camp Registration Form

Please Read Carefully