2019 After Camp Care & Friday Mini Camp

CHERRY CREEK COUNTRY CLUB KID’S CAMP

2019 APPLICATION

Please Note: To ensure your spot, Registration for each individual day must be submitted at least 48 hours in advance of each individual day the child is attending After Camp Care or Friday Mini Camp. Registration will open each Monday, 7 days prior to the Monday of Camp each week. (ie. Registration will open Monday, May 27 to register for any individual days in Week #1: June 3-7.)

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.

Parent's Name*:  
Address*:
Email*: 
Home Phone*:
Cell Phone*:

Child
Name*:
DOB*:
Male Female


PLEASE SELECT THE DAYS:

Week 1: June 3 - June 7 Super Hero Week
Monday 2:30pm - 4:30pm
Tuesday 2:30pm - 4:30pm
Wednesday 2:30pm - 4:30pm
Thursday 2:30pm - 4:30pm
Friday 9:00am - 12:30pm




Week 2: June 10 - June 14 Carnival Week
Monday 2:30pm - 4:30pm
Tuesday 2:30pm - 4:30pm
Wednesday 2:30pm - 4:30pm
Thursday 2:30 - 4:30pm
Friday 9:00am - 12:30pm


 
Week 3: June 17 - June 21 Disney Week
Monday 2:30pm - 4:30pm
Tuesday 2:30pm - 4:30pm
Wednesday 2:30pm - 4:30pm
Thursday 2:30pm - 4:30pm
Friday 9:00am - 12:30pm 



Week 4: June 24 - June 28 Space Week
Monday 2:30pm - 4:30pm 
Tuesday 2:30pm - 4:30pm
Wednesday 2:30pm - 4:30pm
Thursday 2:30pm - 4:30pm
Friday 9:00am - 12:30pm 



Week 5: July 1 - July 5 Patriotic Week
*Camp will be held Monday, Tuesday, Wednesday & Friday
  this week due to the 4th of July Holiday
Monday 2:30pm - 4:30pm
Tuesday 2:30pm - 4:30pm
Wednesday 2:30pm - 4:30pm
Friday 2:30pm - 4:30pm



Week 6: July 8 - July 12 Pirate Week
Monday 2:30pm - 4:30pm
Tuesday 2:30pm - 4:30pm
Wednesday 2:30pm - 4:30pm
Thursday 2:30pm - 4:30pm
Friday 9:00am - 12:30pm 


Week 7: July 15 - July 19 Dr. Seuss Week
Monday 2:30pm - 4:30pm
Tuesday 2:30pm - 4:30pm
Wednesday 2:30pm - 4:30pm
Thursday 2:30pm - 4:30pm
Friday 9:00am - 12:30pm 


 
Week 8: July 22 - 26 Rock Star Week
Monday 2:30pm - 4:30pm
Tuesday 2:30pm - 4:30pm
Wednesday 2:30pm - 4:30pm
Thursday 2:30pm - 4:30pm
Friday 9:00am - 12:30pm 



Week 9: July 29 - Aug 2 Camper Week
Monday 2:30pm - 4:30pm
Tuesday 2:30pm - 4:30pm
Wednesday 2:30pm - 4:30pm
Thursday 2:30pm - 4:30pm
Friday 9:00am - 12:30pm 



Week 10: Aug 5 - Aug 9 Aloha Week
Monday 2:30pm - 4:30pm
Tuesday 2:30pm - 4:30pm
Wednesday 2:30pm - 4:30pm
Thursday 2:30pm - 4:30pm
Friday 9:00am - 12:30pm 

Payment Option

Please note that in order to properly accommodate all children, cancellations must be made no later than one week before the first day of camp.  Late cancellations or no shows will result in full charge. 
Attending: 
   
*If invited guest, name of member sponsor or n/a
 
Member Account  (Members Only)
or Credit Card *We will contact you to get this information
*Member #: (required) 

Child's Medical Information

Medical Information Form Advanced care would be obtained at the hospital of choice or nearest facility depending on the emergency.

  *I initial and I authorize Cherry Creek Kids’ Camp to obtain on-site emergency medical care and also transportation for advanced emergency care for my child. This is a Release of liability, assumption of risk, indemnification, and waiver of legal rights.  Read Carefully.  In consideration of taking part in Summer Kid’s Camp (“Camp”), I, on behalf of my minor child, on my own behalf and the behalf of any of our heirs, administrators, assigns, fully release and discharge the Cherry Creek Country Club and its partners, officers, directors, employees, agents, contractors, insurers and assigns from all claims, demands, liability and causes of action for injury sustained by my child during participation in the Camp.  I agree to indemnify and hold harmless the Cherry Creek Country Club from any claim, demand, liability or cause of action for any injury to my child or me or to my property or my child’s property.  This release includes, but is not limited to, the release of claims based on wrongful death that could be brought by either of our heirs, administrators or assigns, in so far as any such loss is not attributable to negligence.

*Physician of Choice:
*Hospital of Choice:
*Physician Phone #:
*Hospital Phone #:

Emergency Numbers

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



Additional Emergency Contacts:
Name/Home Numbers/Cell Numbers   
Other pertinent Medical information:

Additional persons authorized to pick up child.  Required if any additional person will be picking up your child.
Name, Address, Relationship and Number:  

AUTHORIZATION TO ADMINISTER MEDICATION
To Be Completed by Parent/Guardian only if camper needs medication during the camp day.

Camper Name:  
DOB:
Parent Name:
Email: 
Home Phone:
Cell Phone:
Work Phone

I REQUEST THAT MY CHILD BE ASSISTED IN TAKING THE MEDICINE(S) DESCRIBED BELOW AT CAMP BY CAMP STAFF.

(If more than one medication is required, please complete a separate authorization form for each.)

Name of Medicine:  
Reason for Medication:
Form:
Other Explanation:
Dose:
If Medicine is to be given DAILY, what time:
If Medicine is to be given WHEN NEEDED,
describe indications:
 Possible Side Effects/Adverse Reactions:
 

I authorize for medications for my child.


*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.