McKenna Ranch Camp - Adult Guest Registration Application 2021
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 on their own. The adult guest is required to attend classes and activities with their camper.

Following submission, you will receive a confirmation email from camptheranch@gmail.com. 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 and Relationship to Camper *
(First, Middle, and Last Name)
Camper Name *
Complete Mailing Address (please include city, state, and zip code) *
Email Address *
Phone Number *
Emergency Contact - NAME, RELATION, PHONE NUMBER *
Adult Guest Age & Date of Birth *
Adult Guest Gender *
Which sessions are you attending with your child? (check all that apply) *
Required
Do you plan on spending the night at Camp? *
Do you have any certifications? (check all that apply)
Allergies - FOOD *
Allergies - MEDICAL *
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." This information will only be used in the case of an emergency.
Medical Considerations *
Do you have any medical conditions of which we need to be made aware?
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.
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.
Do you have a law enforcement or military background? If yes, please explain.
Do you consider yourself to be a Christian? *
What is the name of your church? *
Please provide the name and contact information for your pastor or small group leader. *
Have you ever been convicted of a felony or misdemeanor? *
If the answer to the above question was yes, please explain.
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.)
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.
Required
WAIVER/RELEASE FOR COMMUNICABLE DISEASES (INCLUDING COVID-19) ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT
In consideration of being allowed to participate on behalf of McKenna Ranch Summer Camp program and related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. Participation includes possible exposure to and illness from infectious diseases including but not limited to influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my and/or my child's participation in McKenna Ranch Summer Camp; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation in McKenna Ranch Camp and the protection measures against infectious diseases. If, however, I or my child develops any unusual or significant health hazard during his or her presence or participation in McKenna Ranch Camp, a McKenna Ranch Camp staff member will notify me (in the case of minors), and I will remove myself and/or my child from participation and bring such item to the attention of the nearest official immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS McKenna Ranch Camp, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, volunteers, advertisers, and if applicable, owners and lessors of premises used to conduct the event WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION). This is to certify that I, as parent/guardian, with legal responsibility for my child, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.
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, behavior, and health policies. I understand that by submitting this form, I am allowing McKenna Ranch Camp to conduct a background check and to contact my references."
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