Country Club at DC Ranch

Summer Camp Registration

THE COUNTRY CLUB AT DC RANCH SUMMER KID’S CAMP

2017 Camper/Parent Contract

*If you have more children that you would like to signup, the form will prompt you after you click submit.  
  Each child must be entered separately.

Mother's Name*:  
Address*:
Email*: 
Home Phone*:
Cell Phone*:
Business Phone:*
Father's Name*:  
Address*:
Email*: 
Home Phone*:
Cell Phone*:
Business Phone:*

IN ORDER TO CLARIFY THE CAMP’S “STANDARDS OF BEHAVIOR” AND THE CAMP’S “DISCIPLINARY CODE” FOR PARTICIPATION, IT MIGHT BE HELPFUL TO REVIEW THE FOLLOWING ISSUES THAT OCCASIONALLY ARISE.
CAMPERS MAY BE SENT HOME FOR THE FOLLOWING REASONS:
  •  KICKING, JUMPING ON OR PROVOKING FIGHTS WITH ANY MEMBER OF THE CAMP, STAFF OR PARENTAL COMMUNITY.
  • DISRESPECT TO STAFF, MEMBERS, OR OTHER CAMPERS
  • THROWING OF SAND, ROCKS OR ANY OTHER ITEMS THAT ARE NOT MEANT TO BE THROWN INCLUDING SHOES, CHAIRS, STICKS, ETC.
  • RUNNING AWAY FROM THE CAMP GROUP. COUNSELORS WILL BE TRAINED TO ENCOURAGE AND MOTIVATE CAMPER PARTICIPATION. HOWEVER, CAMPERS MUST UNDERSTAND THAT THEY ARE NOT PERMITTED TO RUN AWAY FROM THE CAMP AREA AT ANY TIME.
  • ROUGHHOUSING, HORSEPLAY AND VIOLENT GAMES WILL NOT BE A PART OF THE CAMP.
  • DISTASTEFUL, DEROGATORY OR SPITEFUL JOKES, COMMENTS AND STORIES ARE NOT ACCEPTABLE IN ANY ARENA OF THE CAMP PROGRAM.
IF A CHILD’S BEHAVIOR WARRANTS DISMISSAL FROM THE CAMP, MOM, DAD OR GUARDIAN WILL BE CALLED AND ASKED TO IMMEDIATELY PICK UP THAT CHILD. IF THE PARENTS ARE UNABLE TO RESPOND IMMEDIATELY, THE CHILD WILL BE SEATED IN THE POOL RESTAURANT UNTIL THE PARENTS ARRIVE. THE SECOND TIME A CHILD IS DISMISSED FROM CAMP, THE CHILD WILL NOT BE ALLOWED TO RETURN TO CAMP. THERE WILL BE NO REFUND OF CAMP FEES.

PARENTS PLEASE READ:
  • I UNDERSTAND THAT MY CHILD WILL BE SENT HOME FROM CAMP IF HE/SHE BREAKS ANY OF THE ABOVE RULES. AFTER BEING SENT HOME FROM THE CAMP TWO TIMES, MY CHILD WILL BE DISMISSED FROM THE CAMP FOR THE ENTIRE SUMMER SESSION. IF MY CHILD IS DISMISSED FOR BEHAVIOR RELATED PROBLEMS, SUCH AS THESE, THERE WILL BE NO REFUND OF CAMP FEES.
  • I UNDERSTAND THAT THERE ARE NO REFUNDS AFTER MAY 16th 2017. ALL OF THE DAYS/WEEKS THAT I HAVE RESERVED FOR MY CHILD MUST BE PAID FOR.

I initial and understand the Standards of Behavior


Child
Name*:
DOB*:
Age*:
T-Shirt Size:
Male Female

PLEASE SELECT THE WEEKS:
*Note: FIELD TRIPS ARE ON MONDAYS
Week 5: June 26 - June 30 Monday Tuesday Wednesday Thursday Friday
Session II:
     
Week 1: July 10 - July 14
Monday Tuesday Wednesday
Thursday
Friday
Week 2: July 17 - July 21
MondayTuesdayWednesdayThursday
Friday
Week 3: July 24 - July28
Monday TuesdayWednesday
ThursdayFriday

PLEASE DISCUSS THIS CONTRACT WITH YOUR CHILD BEFORE HE/SHE INITIALS.

In order to clarify the Club’s “Standards of Behavior” and the “Disciplinary Code” for participation, it might be helpful to review the following issues, which occasionally arise.
I may be sent home for the following reasons:
  •  Disrespect of Staff or other children
  • Continued use of electronics after a warning
  • Throwing of ROCKS or any other items that are NOT meant to be thrown, including SHOES, CHAIRS, STICKS, ETC.
  • Running away from the group. Staff will be trained to encourage and motivate participation by all of their kids. However, the children need to understand that they are not permitted to run away from the staff at any time.
  • Roughhousing, horseplay, violent games, dangerous stunts, foul language, uncouth jokes, improper conversations and inappropriate gestures will NOT be tolerated.
I initial and understand the Standards of Behavior


Payment Option
Your member account will be charged half in June and half in July if your child is signed up for both sessions. Otherwise it will be charged in the appropriate month in which you are signed up. If you sign up for the weekly rate and do not show or cancel a field trip after the cancellation date, you will be charged $30 to cover admission and /or transportation fees.
Late Fee/Refund Policy:
You may withdraw your child from Summer Camp 2017 prior to May 12th for a 100% return of your registration fees.
After May 12th there are no refunds for the June session. After June 15th there are no refunds for the July session. If a child does not come to camp on a day they are registered, they will be charged. The fee is based on registrations, not actual attendance.
Attending: 
Optional after camp care until 4 pm for $10 extra daily.
Please note days if you would like this care.

If invited guest, name of member sponsor
Member Account  (Members Only)
or Sponsoring Member
Member Number


Child's Medical Information
*MEDICAL INFORMATION IS IMPORTANT FOR OUR STAFF TO PROVIDE THE BEST POSSIBLE CARE FOR YOUR CHILD

  *I DO HEREBY AUTHORIZE AND CONSENT TO ANY X-RAY EXAMINATION, ANESTHETIC MEDICAL OR SURGICAL TREATMENT RENDERED BY ANY MEMBER OF THE MEDICAL OR EMERGENCY DEPARTMENT STAFF LICENSED UNDER THE PROVISIONS OF THE MEDICINE PRACTICE ACT OR A DENTIST LICENSED UNDER THE PROVISIONS OF THE DENTAL PRACTICE ACT AND ON THE STAFF OF ANY ACUTE GENERAL HOSPITAL HOLDING A CURRENT LICENSE TO OPERATE A HOSPITAL FROM THE STATE OF ARIZONA.
IT IS UNDERSTOOD THAT THIS AUTHORIZATION IS GIVEN IN ADVANCE OF ANY SPECIFIC DIAGNOSIS, TREATMENT OR HOSPITAL CARE DEEMED ADVISABLE BY THE AFOREMENTIONED PHYSICIAN IN THE EXERCISE OF HIS/HER BEST JUDGEMENT. IT IS UNDER- STOOD THAT EFFORT SHALL BE MADE TO CONTACT THE UNDERSIGNED PRIOR TO RENDERING TREATMENT TO THE PATIENT, BUT THAT NONE OF THE ABOVE TREATMENT BE WITHHELD IF THE UNDERSIGNED CANNOT BE REACHED.


*Insurance Company under
which my child is covered:
*Physician Phone #:
*Pediatrician to Contact:

Emergency Numbers
Mother Home #:
Mother Work #:
*Mother Cell #:
Father Home #:
Father Work #:
*Father Cell #:



Additional Emergency Contacts:
Name/Home Numbers/Cell Numbers   
Relationship and Other information:


List of Activities to be Omitted:  
List Any Physical Limitations:
List Any Food Allergies:
List Any Recent Spells of Convulsions,
Concussions or Loss of Consciousness:
List any Problems with Social or Motor Skills:
List any Special Medications (Insulin,Ritalin, ETC, )
that Must Be Taken while at Camp



*By typing your name in this box, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.



If you have more children that you would like to signup, the form will prompt you after you click submit.
Each child must be entered separately.