Camp 2017 Registration

CHERRY CREEK COUNTRY CLUB KID’S CAMP

2017 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.

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

Child
Name*:
DOB*:
Male Female

Junior Creeker Golf Academy is available as an add-on to Kid’s Camp.  For more information or to register for the Junior Creeker Golf Academy offered on Wednesdays, please contact the Pro Shop at 303-597-0370.   Please note The Jr. Golf Academy will not be offered during week 6 or week 10

PLEASE SELECT THE WEEKS:
Week 1: June 5 - June 8
Week 6: July 10 - July 13*Science, Drama, Arts and Crafts Weeks: Please note, these weeks will entail activities oriented in these categories as opposed to other weeks where activities are sports oriented.
Week 2: June 12 - June 15 FULL *Please call to be added to the wait list for this week.

Week 7: July 17 - July 20
Week 3: June 19 - June 22

Week 8: July 24 - July 27
Week 4: June 26 - June 29

Week 9: July 31 - August 3
Week 5: July 3 - July 7 *Camp will be held Monday, Wednesday, Thursday & Friday this week due to the 4th of July Holiday

Week 10: August 7 - August 10*Science, Drama, Arts and Crafts Weeks: Please note, these weeks will entail activities oriented in these categories as opposed to other weeks where activities are sports oriented.
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.  No pro-rating is available for missed days or if your child cannot attend the full week of camp. Members will be considered children and grandchildren of Members only.  Invited guests are limited to 3 weeks of camp.  One guest child per each Member child is permitted.

Attending: 
  
If invited guest, name of member sponsor
 
Member Account  (Members Only)
or Credit Card *We will contact you to get this information
Member Number 

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.