C L Summer Day Camp Application 2019
Summer camp application for Day campers
Name *
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Camper Gender *
Name used most *
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Birthdate *
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Age *
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City *
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Address *
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State *
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Zip Code *
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School *
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Grade *
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Father's Name
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Mother's name
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Primary phone *
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Secondary phone
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E-Mail *
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I became interested in Cedar Lodge through?
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Others who may be interested in Cedar Lodge:
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Others who may be interested in Cedar Lodge:
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Foods: Meals at Cedar Lodge are served family style and are nutritious and ample. Locally grown foods are used whenever possible. Milk, water, and a substitute beverage are served at every meal. Salads and fresh fruits are always available. Those campers on a full vegetarian diet must be so-noted on the “special needs” form and will be supplied with an adequate meal selection.
Medical: Cedar Lodge maintains a full time medical officer on the camp staff to take care of the daily medical needs of all campers. There is no charge for this service. Camp families are responsible for any additional medical expense incurred by their camper due to illness or accident while at camp. We require the information of your insurance carrier and policy number on our Camp Health Form.
Day Campers:
Sign me up for Week 1, please check all that apply
6/16-6/23/19
Sign me up for Week 2, please check all that apply
6/23-6/30/19
Sign me up for Week 3, please check all that apply
6/30-7/07/19
Sign me up for Week 4, please check all that apply
7/07-7/14/19
Sign me up for Week 5, please check all that apply
7/14-7/21/19
Sign me up for Week 6, please check all that apply
7/21-7/28/19
Sign me up for Week 7, please check all that apply
7/28-8/04/19
Sign me up for Week 8, please check all that apply
8/04-8/11/19
CEDAR LODGE POLICY on Payments, Cancellations, Early and Late Arrivals: Refunds will be made as funds are available and no later than the beginning of camp. Payments to Cedar Lodge: Payment through check: These can be for a deposit, full amount or partial payment as long as full payment is made by May 1st. Make out to "Cedar Lodge" and sending it to: Cedar Lodge, PO BOX 218, Lawrence, MI 49064. Payments through Credit Cards; we are set for most common credit cards: ALL Credit Card payments will be charged an additional 3.5% to cover credit company charges to us. We can take cards:1)On line-through paypal. Either contact us and we will send you a “click and pay” invoice, or “send us money” through paypal using info@cedarlodge.com. You do not need a paypal account to have us send you an invoice through this method. OR e-mail us at: campcedarlodge@gmail.com and we will send you a click and pay credit card invoice. 2)Phone us-we can take your information off the phone at (269)674-8072. 3)Swipe your card when you get here (only applies to weekends, or in-camp payments, as camp balance is due by May 1st. International Payments: Any of the above or we can receive wire transfers. Contact us for more information. *
Required
Until March 31st: Any payments made, less $100.00 cancellation fee, is refundable. From April 1st to May 1st: Deposit is non refundable. All other payments made, less a $100.00 cancellation fee (in addition to deposit amount), are refundable. After May 1st, No refunds for cancellations or no shows. -Payment must be paid in full by May 1st. Payment plans available upon request. -A fee of $25.00 will be billed for all returned checks. -Any applications that are posted after May 1st must be accompanied by payment in full. -There will be no refunds made for a camper leaving camp during any camp session, including for reasons of homesickness or misbehavior, except with the written verification of a physician of an injury or physical illness AND if the director and camp Health Officer agree it is in the child’s and camp’s best interest that the child leave camp. -There will be no refund for early departure if a parent decides to remove their son or daughter from camp against the director’s advice. -Any camper or staff member found using alcohol, marijuana, or non-prescribed drugs on the camp’s grounds or on field trips will be sent home immediately. No refunds will be issued. Any prescribed medication that a camper brings to camp must be given to the Camp Health Director, in the original prescription bottle and be a current prescription in the camper’s name. -There is no reduction in fees for those campers arriving late or leaving early. In case of serious illness or injury, one half of the non-expired camp fee will be refunded, or applied against further camp seasons.
Permission for photographs: I, as a parent or guardian of a camper, individually and on behalf of the camper, hereby grant permission for Camp Cedar Lodge to use any photographs, video, or voice testimonials of my camper taken during the camping session in newspapers, magazines, brochures, web sites, or other media for promotional purposes. I understand that no names will be used.
Camp Cedar Lodge, Cedar Lodge Stables, and The Land Company Release and Waiver  I forever release and discharge Camp Cedar Lodge, Cedar Lodge Stables, The Land Company, all their employees, all their agents, all their members and managers, and the staff and teachers of this Summer Camp, Year around facility and Stables for any liability that may occur during my as an adult, or my child’s visit/stay. This release is in addition to any other release, including any horseback riding release, and shall not be construed to narrow or restrict any such other release. I understand that any minors with our group while visiting camp or stable will be the responsibility of our group. I also understand that if my child while taking lessons, visiting the barn, or on the grounds is solely still my responsibility. Lastly, I understand I am totally responsible for any risk I as an adult take or decisions I make while on this facility. -I AGREE in consideration for my or my child’s participation of all Equestrian related activities to the following: -I AGREE that that I or my child is participating voluntarily with either our horse or a horse provided to us by Cedar Lodge Stables. I am fully aware and acknowledge that horse sports involve inherent dangerous risks of accident, loss, and serious bodily injury. -I AGREE to release Camp Cedar Lodge, Cedar Lodge Stables, and The Land Company from all claims for money damages. -I AGREE to pay any losses, damages, or costs incurred and to hold Camp Cedar Lodge, Cedar Lodge Stables and The Land Company harmless with respect to claims for harm to me, my child, our horse(s), or equipment. -I understand about protective equipment, and I understand that I and my child is entitled to wear protective equipment without penalty, and I acknowledge that Camp Cedar Lodge and Cedar Lodge Stables requires us to do so, while WARNING that no protective equipment can guard against all injuries. - I am either an adult or a parent or guardian of a minor equestrian and I consent to either my or the child’s participation and AGREE to all of the provisions and AGREE to assume all of the obligations of this Release on my or my Child’s behalf. -I AGREE that Camp Cedar Lodge, Cedar Lodge Stables and The Land Company as used above includes all of their officials, officers, directors, employees, agents, personnel, volunteers and affiliated organizations. BY SIGNING BELOW I further AGREE to be bound by all applicable Camp Cedar Lodge, Cedar Lodge Stables and The Land Company rules, terms and provisions of their organization. Please Note: 1994 Public Act House Bill No. 5004 WARNING: Under the Michigan Equine Activity Liability Act, an Equine professional is not liable for an injury to or the death of a participant in an equine activity resulting from an inherent risk of the equine activity. *
Required
I attest that I am the responsible signing person for: (name of minor) *
Your answer
And that I am agreeable to the terms of Cedar Lodge, including Waiver release, payment information and everything above. *
Name of Parent or Gaurdian of minor
Your answer
Date *
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A deposit of $100.00 for each week reserved must be received by Cedar Lodge for this application to be valid. The balance of the tuition is due by May 1st 2019. Payment plans available. This tuition includes room, board, laundry and all camp activities taking place on the camp grounds. *
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