2015 Application - Rocky Mountain Christian Camp

Application due June 22nd
To assist us in planning for RMCC, please send in
application as soon as possible. All campers must
send in an application.
NO APPLICATIONS ARE ACCEPTED
AFTER JULY 6TH, 2015
Application
Camp dates: July 11-18, 2015
Rocky Mountain
Christian Camp
shauneglowicki@yahoo.com
Camper
Late Registration Fee of $25 if received
June 23, 2015 or later!
Junior Counselor
CAMPER’S NAME: ______________________________________________________________________
ADDRESS: ________________________________________________________________
DATE: ____ / ____ / ________
E-MAIL ADDRESS: _______________________________________
(MANDATORY—ALL CORRESPONDENCE WILL BE BY E-MAIL)
CITY:
STATE:
PARENTS’ NAME(S): _________________________________
ZIP:
PHONE NUMBER:
DATE OF BIRTH:
/
/
WHERE PARENTS CAN BE REACHED IF NOT AT HOME: ___________________________________________________________________________________
HEALTH INSURANCE COMPANY AND POLICY NUMBER: _________________________________________________________________________________
Please complete the medical release form in addition to this application. This is needed to allow your camper at camp.
PASTOR’S SIGNATURE (WELS) REQUIRED : ___________________________________
GRADE (FALL 2015):
DAYS ATTENDING: _______
HOME CHURCH: _____________________________________________
SEX: _______
SUGGESTED TENTMATES (for campers only): ________________________________________________________________________________________
JUNIOR COUNSELORS: Requirement to be a Junior Counselor, one must have previous experience as a RMCC camper or JC and be entering the 10th grade or
higher no exceptions. The number of Junior Counselors may be limited if overall camp exceeds recommended number. JC’s must be available for the entire
session.
By applying to come to RMCC, I agree to abide by all camp rules and requirements. I understand that failure to abide by the camp rules and
requirements may result in being dismissed from RMCC. All electronic devices will not be permitted at RMCC. This includes iPods, cell phones,
M P 3 ’ s , etc. RMCC does not permit these items for reasons of safety, security, accountability, and the temptation to steal. If these items are
found they will be confiscated by the RMCC staff.
I further agree to show proper respect to all camp counselors and fellow campers. I also promise not to damage or destroy any property of
fellow campers, other individuals, RMCC, or the U.S. Government.
CAMPER’S SIGNATURE: _____________________________________________
Must be completed to be allowed into camp.
PARENT/LEGAL GUARDIAN SIGNATURE: _____________________________________________
Must be completed to be allowed into camp.
PARENT/LEGAL GUARDIAN: I certify that this camper is in good health and has permission to engage in all camp activities. In case of accident or serious
illness, I hereby authorize RMCC to make whatever arrangements seem necessary. If RMCC decides to obtain medical attention, I hereby authorize the medical
experts to take whatever steps seem necessary for the health of the camper. My insurance will serve as the primary coverage f or all necessary medical treatment.
I hereby release, discharge and/or otherwise indemnify RMCC and its affiliated organizations, their employees and associated personnel including the owners of
facilities utilized for the RMCC, against any claim by or on behalf of the camper as a result of the camper’s participation in the RMCC. Please note any health
factors or other stipulations on the back of the application or attach separate sheet of paper to application which you feel RMCC needs to know.
PARENT/LEGAL GUARDIAN SIGNATURE: _____________________________________________
Must be completed to be allowed into camp.
Two camp activities require the camper to have the ability to swim. We have inflatable rafts which we use on Turquoise Lake. The campers are required to wear
life vests while rafting and there is always a counselor raft in the water. We also go to swimming pool facilities near Leadville. I hereby give my child (camper)
permission to take part in the above activities.
PARENT/LEGAL GUARDIAN SIGNATURE: _____________________________________________
Must be completed to be allowed into camp.
To assist us in planning of RMCC, please send application in as soon as possible. All campers, JC’s must submit application no exceptions.
Fees:
• Camper and Junior Counselor: $120 – This includes 2 punch cards for canteen use throughout the week.
• Late Registration Fee: $25.00
if received June 23 or later.
• Cancellations by June 27th will receive a full refund. No refunds if cancellations occur after June 27th.
•
•
•
•
•
Your application is not complete until we have received your fee, this application, and the following documents:
Medical Release Form
Permission Form
Promises and Goals Sheet (filled out by camper or JC)
Request to give medication form (if applicable)
Please return this application with check to the following
address:
RMCC
c/o Lord of Life Lutheran Church
12021 Northaven Circle
Thornton, CO 80241
Please direct any questions to Mrs. Shaun Glowicki at : shauneglowicki@yahoo.com
Please note: No cell phones are allowed. If you need to reach your child for an emergency, phone numbers are posted at:
http://rmcc-wels.com/Contact_Us.html