2020 Ranch Camp Registration Form

The cost for camp is $118.00 per week and includes all activities, meals, T-shirt, and craft supplies. Camp fees are refundable (less a $10 processing fee) if cancellations are received seven days prior to the start of the camp but non-refundable beyond this date. Registrations are on a first-come, first serve basis. To register complete the form below with the required payment and mail to Cornerstone Kids’ Ranch, 11960 County Road 3536, Ada, OK74820. Checks should be payable to Cornerstone Kids’ Ranch. Sorry, we cannot hold registrations without payment. A late fee of $10 will be applied to all registrations received 7 days or less from the start of the camp you will be attending.

Camper's Name

First Name

Last Name

Week Attending

Week 1: June 1-4

Week 2: June 8-11

Week 3: June 15-18

Week 4: June 22-25

Week 5: June 29-July 2

Grade Completed

Date of Birth

YYYY

Age

Gender

Male

Female

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent or Legal Guardian

First Name

Last Name

Contact Phone

(###)

###

####

Contact Email

T-Shirt Size

Special Conditions

Child's Physician

Physician Office Number

Parental Consent Statement

I hereby declare my consent for my child named above to participate in the activities conducted by Cornerstone Kid’s Ranch. I recognize that there may be occasions where the child named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of Cornerstone Kid’s Ranch to seek and secure any needed medical attention or treatment for the child named above including hospitalization, if in the agent’s opinion such need arises. In doing so I agree to pay all fees and costs arising from this action to obtain medical treatment. I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment. I give permission and consent for Cornerstone Kids’ Ranch to take photos and video of my child during camp session activities and consent that any such recordings may be published and used by Cornerstone Kids’ Ranch and its agents, to illustrate and promote the camp and the ministry of the ranch. I further agree to indemnify and hold harmless Cornerstone Kid’s Ranch and its leaders, employees, volunteers, or agents from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of my child during such activities.

I have read and agree with the statement above.