Registration | Promise Ranch Ministries

Camper Registration

Camper Name
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Select a Camp (Use Dropdown below)
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Age of the camper at time of the event:
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Parent/Guardian Name
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Phone Number
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Emergency Contact
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Emergency Contact Phone Number
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Address
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- Street Address
- Address Line 2
- City
- State / Province / Region
- Postal / Zip Code
- Country
Parent E-Mail
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List anyone other than you that may be picking up or bringing your child to camp.
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List anyone that your child may not be transported by.
A $25.00 Registration fee is required: You may submit thru PayPal or mail us a check to Promise Ranch Ministries 106 Meadow Lane McAlisterville, PA 17049. - PayPal Registration Fee:
Financial scholarship of $100 may be available, if you can apply any of the following to your camper. The Balance of the Camp Fee will need to be paid by the first day of your campers camp.
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Low Income (camper must qualify for free or reduced school lunches)
Foster Care
Incarcerated Parent or Step-Parent
I am not seeking a scholarship for my child
Medical Information:
Please List all Prescription and Non-prescription Medications along with dosing instructions.
Is your camper in general good health & able to participate in all normal camp activities or is there a pre-existing condition that would limit your camper, Please describe?
I attest that my child is up to date on all vaccinations and Tetanus shots.
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My child is up to date on vaccination.
My child is up to date on Tetanus Shots.
My child is not up to date
Does your camper have any allergies we should be aware of? If so, please list these allergies below and treatment given.
Does your camper have any special dietary needs and Reason for need?
Who is your campers Primary Care Physician and Phone Number?
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Health Insurance information:Company and policy number?
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Acknowledgements, Waiver, Photo Release, etc.
Comments
By Checking this box I agree with all the information provided and the all the information I provided to be true. I have read the Acknowledgements, Waiver, Photo Release section and I understand the by checking this box it is my electronic signature.
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I agree and I am finally done with this form !
I do not agree to all or a portion and will email Promise Ranch with my concerns. (prm@promiseranchministries.com
Please click on the checkbox to continue
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Camper Registration

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or

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Application

Registration Fees of $35 is due at time of registration thru PayPal

or mailed to the Promise Ranch