C H E L E Y C O L O R A D O C A M P S , I N C . (A) APPLICATION & TERMS OF AGREEMENT, AND (B) ACKNOWLEDGMENT AND ASSUMPTION OF RISKS & RELEASE AND INDEMNITY AGREEMENT Winter: September–May Summer: May–September 601 Steele St PO Box 6525 Denver CO 80206-0525 3960 Fish Creek Rd PO Box 1170 Estes Park CO 80517-1170 Phone 303-377-3616 Fax 303-377-3605 Phone 970-586-4244 Fax 970-586-3020 E-mail [email protected] Website www.cheley.com The applicant or parent/s or legal guardian/s (for applicants under 18 yrs. of age), must read and complete the Application and Terms of Agreement, and read and sign the Acknowledgment and Assumption of Risks & Release and Indemnity Agreement in this foldout. _____________________________________________________________________________________________________________ M Male M Female Camper’s Name: Last, First _______________________________________________________________________________________ Date of Birth______________ /_________ /___________ Camper’s E-mail Month Day Year _________________________________________________________________________________________________________________________________________ Primary Street Address City, State, Zip, Country _________________________________________________________________________________________________________________________________________ Home Phone Family E-mail Address Current School Grade completed by start of camp _________________________________________________________________________________________________________________________________________ Parent 1 Name Profession Work Phone Work E-mail _________________________________________________________________________________________________________________________________________ Parent 2 Name Profession Work Phone Work E-mail Are parents divorced or separated? Yes____ No____ If yes, parent camper lives with ________________________________ Either parent deceased? ________ Was any family member a Cheley camper or staff member? If so, name at camp and year(s) ________________________________________________________ This will be my ______ summer at Cheley (1st, 2nd, 3rd, etc.) M If returning, check if you would be willing to act as a reference for new families. Camper T-shirt size: M Youth Medium M Youth Large M Small M Medium M Large M X-Large We learned about Cheley from _____________________________________________________________________________________________________________ _____________________________________________________________ _________________________________________________________________________________________________________________________________________ Billing Name (if different) Relationship to camper Phone E-mail _________________________________________________________________________________________________________________________________________ Billing Address City, State, Zip, Country M Please check if you would you like duplicate mailings sent to this address. _____________________________________________________________ M Full Term M First Term M Second Term __________________________________________________________________________________________________________________________________________ M Boys’ Trail’s End Ranch for boys 12-17 (completed grades 6-11) M Girls’ Trail’s End Ranch for girls 12-17 (completed grades 6-11) M Lower Ski Hi for boys 9-11 (completed grades 3-5) M Lower Chipeta for girls 9-11 (completed grades 3-5) M Ski Hi for boys 12-13 (completed grades 6-8) M Chipeta for girls 12-13 (completed grades 6-8) M Haiyaha for boys 14-17 (completed grades 8-11) M Senior Chipeta for girls 14-17 (completed grades 8-11) _____________________________________________________________ Deposit Information – Deposit of $800 is due with this application. M Cash M Check #____________ M Visa M MasterCard Name on Credit Card____________________________________________________ _________________________________________________________________________________________________________________________________________ Credit Card # Expiration Date Signature M Please check if you would like us to charge this credit card automatically when each billing is due. TERMS OF AGREEMENT IntIntroduction:roduction: ItIt isis importantimportant that allall campers,campers, paparentsrent/s or TERMSlegal guaguardian/srdian/s OF AGREEMENT2.pr ogramThe camper starts termon a isW ednesday27 full days, and and ends parents on a Monda and campersy, and has should a ca rmakeefully (collectively pa“parent/s”)rent/s) andand sta staffff members members have have a full a fullunderstanding understanding of, and of, noplanned “deals” beginning, regarding middle the time and of end. departure, Campers after mustcamp complete begins. The the Cheleyentire andIntbe rinoduction: be ag inr eementagreement It is with, impo with, thertant the overall that overall allCheley campers,Cheley Colorado Colorado parent/s Camps, Camps, or TERMSlegal Inc. Inc. gua(Cheley) (togetherrdian/s OF AGREEMENTprogrampterrogramm. stastartsrts onon aa WTuesdayednesday and and ends ends on on a a Sunday, Monday ,and and hashas aa carefullycarefully with(collectively its parent pa company,rent/s) andsubsidiaries, staff members owners, have officers, a full understanding directors, employees, of, and planned beginning, middlemiddle andand end.end. CampersCampers mustmust completecomplete thethe entireentire philosophy, ideals, goals, and policies. The Cheley Camp program is a 3. In fairness to the individual camper, other campers and counselors, Intagents,bepositive rinoduction: ag andrepresentatives,reement const It is with, rimpouctive ther tant outdoosuccessors, overall thatr, all active,Cheley campers, assigns, gColoradoroup pa livingvolunteersrent/s Camps, experience. or legaland Inc. allgua (Cheley) Camperspersonsrdian/s term.pterogramrm. starts on a Wednesday and ends on a Monday, and has a carefully (collectively parent/s) and staff members have a full understanding of, and campers who may wet the bed (more than once a week) are not accepted. affiliatedphilosophare expected y,with ideals, to it, pa andr ticipategoals, its independent andenthusiastically policies. contractors, The in all Cheley campindividually activities.Camp andprogram collectively, is a planned3. In fai beginning,rness to the middle individual and end. campe Campersr, other campersmust complete and counselors, the entire be in agreement with, the overall Cheley Colorado Camps, Inc. (Cheley) referredpositive andto herein const rasuctive “Cheley”) outdoo philosophy,r, active, gr oupideals, living goals, experience. and policies. Campers The tecampers4.r m.Parent/s who and may camperswet the bedcommunicate (more than byonce mail, a week) sent aoutre notdaily accepted. from the philosophCheleyOurare expectedCampers: Campy, ideals, to programW pae ser ticipategoals,rve is young a andenthusiasticallypositive people policies. and from constructive allThe in 50 all Cheley states, camp outdoor, activities. Campas well p asactive,rogram from groupmanyis a Estes Park Post Office. We allow one-way e-mail communication from parent 3.4. InPa rfaient/srness and to campersthe individual communicate camper , byother mail, campers sent out and daily counselors, from the positivelivingforeign experience. countries.and const CampersrAlluctive maor outdoo arefaiths expectedr, active,are rep to gresented rparticipateoup living in experience.our enthusiastically camp communit Campers in ally, campersto camper who (small may fee).wet the Phone bed (mocallsre betweenthan once pa ar entsweek) and are campers not accepted. are not acampOurandre expectedCampers:the activities. camp to Wp pareograms serticipaterve young ar eenthusiastically open people to frboysom all inand 50 all girlsstates, camp of activities. ashigh well characte as fromr ,many who peEstesrmitted. Park Post Office. We allow one-way e-mail communication from parent foarreeign emotionally countries. well All and maor physically faiths afit.re rCheleyepresented does innot our discriminate camp communit in theiry, 4.to camperParent/s (small and campersfee). Phone communicate calls between by mail,parents sent and out campers daily fr omare thenot Ourand Campers:the camp Wperograms serve young are open people to frboysom all and 50 states,girls of ashigh well characte as fromr ,many who Estespermitted. Park Post Office. We allow one-way e-mail communication from parent admissions policies on the basis of race, color, gender, religion, national Medical Treatment and Consent: I authorize Cheley staff, representatives, foaorrr eeignethnic emotionally countries. origin, well ageAll and maoror physicallydisabilit faiths y.a fit.r eCheley rCheleyepresented is does not, innot howeveour discriminate campr, acommunit treatment in theiry, to camper (small fee). Phone calls between parents and campers are not andadmissions the camp policies programs on theare basisopen toof boysrace, andcolo girlsr, gende of highr, religion, characte nationalr, who pecontractorsrmitted. or other medical personnel to obtain or provide medical care for center, and Cheley staff are not trained to deal with campers who have Medicalme or my T child,reatment to transpo and Consent:rt me or my I authorize child to a Cheleymedical sta facilityff, rep andresen to tatives, provide aorsevere ethnic emotionallyre mental, origin, physicalwell age and or or physicallydisabilit emotionaly . fit. difficulties. Cheley Cheley is does not, W enot dohoweve discriminate reser,ve a thetreatment inright their to contractors or other medical personnel