McKenna Ranch Camp - Adult Guest Registration Application 2020
McKenna Ranch Camp is a Christian centered youth camp, owned and operated by Kathy McKenna Mueller, that is filled with outdoor adventure! We explore, discover, and challenge every youth to pursue a deeper relationship with Jesus Christ. Our counselors, volunteers, and staff are passionate about the outdoor experience, where God reveals His invisible attributes, eternal power, and divine nature. (Romans 1:20)

We offer the option for parents to accompany their child(ren) to camp when the youth is under the age of 8 years old, or if the youth has a medical condition or disability that prevents he/she from having a successful camp experience. The adult guest is required to attend classes and activities with their camper.

Following submission, you will receive a confirmation email from Notification of acceptance or denial of the adult guest availability will be communicated via email within one month. Adult guests who are accompanying their children will be charged $50.00 per session.
Adult Guest Name *
Your answer
Camper Name *
Your answer
Complete Mailing Address (please include city, state, and zip code) *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Emergency Contact - NAME, RELATION, PHONE NUMBER *
Your answer
Adult Guest Age & Date of Birth *
Your answer
Adult Guest Gender *
Which sessions are you attending with your child? (check all that apply) *
Do you plan on spending the night at Camp?
Do you have any certifications? (check all that apply)
Allergies - FOOD *
Your answer
Allergies - MEDICAL *
Your answer
Insurance Coverage *
Please provide the company, name of the person who is primarily insured, the policy number, and the group number. If you do not have medical insurance, please mark this field as "NONE."
Your answer
Medical Considerations *
Do you have any medical conditions of which we need to be made aware?
Your answer
Medical Considerations - Continued
If you answered yes to the above question, will your medical consideration prevent you from participating in rigorous camp activities? (Hiking, swimming, physical exertion in extreme heat) Please explain.
Your answer
Medications (Please list the medications that will be need to be administered at camp.) *
NOTE: The taking of prescription medication is the responsibility of the individual taking the medication and/or that individual. A Health Officer will be available during each session, and all medications (prescription and otherwise) must be turned in to the Health Officer upon arrival.
Your answer
Do you have a law enforcement or military background? If yes, please explain.
Your answer
Do you consider yourself to be a Christian? *
What is the name of your church? *
Your answer
Please provide the name and contact information for your pastor or small group leader. *
Your answer
Have you ever been convicted of a felony or misdemeanor? *
If the answer to the above question was yes, please explain.
Your answer
McKenna Ranch will conduct background checks on all of their staff members, counselors, volunteers, and adult guests. Do you willingly submit to this background investigation? *
Child Safety Training *
All McKenna Ranch Camp staff members, counselors, volunteers, and adult guests are required to have child safety training and certification that is approved by the state of Texas. Do you agree to take the steps necessary to complete this training?
Do you smoke? *
Do you use drugs that are illegal in the state of Texas? *
Do you have a valid driver's licence?
Will you be driving your own vehicle to camp?
Clothing Agreement *
Due to the nature of activities during the summer camp sessions, each person will be required to bring shoes and clothing that is appropriate for hiking in rocky terrain. As a reminder, McKenna Ranch is a Christian organization; campers, CITs, counselors, volunteers, adult guests, and staff members are required to dress modestly at all times.
Character Reference *
Please provide a reference who can vouch for your dependability, responsibility, character, and trustworthiness. Please provide the name, phone number and email address of your reference, along with the number of years you have known them. (This should not be a family member.)
Your answer
McKenna Ranch Safety Statement *
The activities at McKenna Ranch Camp involve challenging the activities that require a variety of different skills and physical endurance. These activities are taught by mature, experienced instructors and safety is stressed with utmost importance. Activities may include: hiking, mountain climbing, overnight camping, swimming, dart board, sling shot, horseshoes, whittling, leather crafts, camp crafts, Indian lore, equine, and natural sciences. Although many of these activities are inherently dangerous, every effort will be made to ensure the safety of everyone.
McKenna Ranch Camp - Behavior Policy *
The McKenna Ranch Camp is a Christian youth camp, privately owned and operated, on the McKenna Ranch, in Del Rio, TX. We hold our campers, counselors, volunteers, adult guests, and staff to a high moral standard. Behavior that is destructive, manipulative, violent, reckless, sexual, or in any way inappropriate will not be tolerated. Foul language is prohibited. If safety and/or behavior standards are not followed by a particular camper, counselor, or staff member, then he/she will will be removed from camp, and legal action will be taken if necessary. McKenna Ranch Camp reserves the right to dismiss any person for misconduct or disobedience to camp rules.
Photo Release *
I hereby assign and grant to the McKenna Ranch the right and permission to use and publish the photographs/film/videotapes/electronic representations and/or sound recordings made of me or my child at all camp activities, and I hereby release the McKenna Ranch and the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all liability from such use and publication. I hereby authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/film/videotapes/electronic representations and/or sound recordings without limitation at the discretion of the McKenna Ranch, and I specifically waive any right to any compensation I may have for any of the foregoing.
Informed Consent and Release Agreement *
In case of an emergency, I understand that every effort will be made to contact the individual listed as the emergency contact person. In the event that this person cannot be reached, permission is hereby given to the medical provider selected to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication. Medical providers are authorized to disclose protected health information to any physician or health care provider involved in providing medical care to the participant. Protected Health Information/Confidential Health Information PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, spouse, and/or determination of the participant’s ability to continue in the program activities. I have carefully considered the risk involved and give consent for myself to participate in camp activities. I approve the sharing of the information on this form with McKenna Ranch volunteers and professionals who need to know of medical situations that might require special consideration for the safe conducting of all activities at McKenna Ranch.I release the McKenna Ranch, its owner Kathryn McKenna Mueller, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation.
Digital Signature *
"By typing my name in the space below, I acknowledge that the information provided in this form is true and correct to the best of my knowledge. I have read, accepted, and understand the McKenna Ranch Camp's safety and behavior policy. I understand that by submitting this form, I am allowing McKenna Ranch Camp to conduct a background check and to contact my references."
Your answer
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