McKenna Ranch Camp - Camper Registration
McKenna Ranch Camp, owned and operated by Kathy McKenna Mueller, is a Christian centered youth camp. All campers experience the wonders of God's creation, which reveal the invisible attributes of God ~ clearly evident from His Creation.
McKenna Ranch Camp is licensed by the Texas Department of State Health Services (ID #250867). Registration can be completed by your submission of this form. Parents will need to fill out a registration form for each camper. Once the submission has been verified, a PayPal link will be emailed to the Parental Contact listed below. For families registering more than one child, sibling discounts will be applied, and a single payment request will be sent via PayPal. If you would like to pay via check or cash, please specify in the appropriate field below. Early registration discounts for the June 2019 summer sessions are valid between January 20th and March 18th. After this date, registration fees are considered to be full price. *A camper is considered to be a child between the ages of 8-15 years old. First time campers between the ages of 6-7 will be admitted on the condition that a parent or guardian accompanies them. Prices for adult chaperones can be obtained upon request.
Camper Name *
Your answer
Family Mailing Address *
Mailing Address, City, State, Zip Code
Your answer
Parental Contact - EMAIL ADDRESS *
Your answer
Parental Contact - NAME *
Your answer
Parental Contact - PHONE NUMBER *
Your answer
Alternate Emergency Contact - NAME *
Your answer
Alternate Emergency Contact - PHONE NUMBER *
Your answer
Camper Age & Birth Date *
Your answer
Camper Gender *
T-Shirt Size *
This year, t-shirts will be issued to campers and CITs at no additional cost.
Session Attending (check all that apply) *
PRICE PER CAMPER, PER SESSION = $425 / EARLY REGISTRATION PRICE = $375 / SIBLING DISCOUNT = 15% / MULTIPLE SESSION DISCOUNT = 15% (*Sibling Discounts & Multi-Session Discounts cannot be combined)
Would you like to add Snack Shack Bucks? *
Would you like to purchase a camp photo album? ($24.00 each) *
Camper Allergies - FOOD *
Your answer
Camper Allergies - GENERAL
Your answer
Camper Allergies - MEDICAL *
Your answer
Camper Insurance Coverage *
Please provide the company, name of the person who is primarily insured, the policy number, and the group number
Your answer
Camper Medical History *
Are there any medical conditions of which we need to be made aware? Please explain.
Your answer
Camper 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’s parent or guardian. 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
Camper Swimming Ability *
Camper Clothing Agreement *
Due to the nature of activities during the June 2019 summer camp sessions, each camper and CIT 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, and staff members are asked to dress modestly at all times.
McKenna Ranch Safety Statement *
The activities at McKenna Ranch Camp involve challenging the camper to experience and learn a variety of different skills. 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, and natural sciences. Although many of these activities are inherently dangerous, every effort will be made to ensure the safety of every camper.
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. Each camper is taught and instructed from the Bible (God’s Holy Word) and challenged with life lessons and memorization of scripture. We hold our campers, counselors, and staff to a high moral standard. Behavior that is destructive, manipulative, violent, reckless, or in any way inappropriate will NOT be tolerated. If safety and/or behavior standards are not followed by a particular camper, counselor, or staff member, then he/she will not be allowed to participate and will be removed from camp. McKenna Ranch Camp reserves the right to dismiss any camper for misconduct or disobedience to camp rules. In the case of a camper dismissal, the parent or guardian would be required to pick up the camper immediately.
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.
Health Record Release *
Due to the regulations set forth by the Texas State Department of Health and Human Services, McKenna Ranch must keep a copy of health records for each camper. Please be aware that campers will not be allowed to attend camp unless they provide a copy of these records. Upon arrival, these records must be presented to the Health Officer.
Payment Information *
For those paying via CHECK- An emailed statement from McKenna Ranch ( will be sent to you upon submission of this form. Payment MUST be received within 7-10 days. For those paying via PAYPAL - An emailed money request will be sent to you. You do not need to have a PayPal account in order to complete payment. Payment must be received within 5-7 days.
Sibling Discount Information
If you will be registering more than one camper or CIT and wish to take advantage of the sibling discount, please specify the names of the additional children you will be enrolling.
Your answer
Informed Consent and Release Agreement *
In case of an emergency involving me or my child, 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 by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for me or my child. Medical providers are authorized to disclose protected health information to the adult in charge, camp medical staff, camp management, and/or 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, 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 and/or my child 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 - PARENT / GUARDIAN *
"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 registering my child for McKenna Ranch Camp during June 2019, and I am responsible for all fees associated with this enrollment."
Your answer
Digital Signature - CAMPER *
"By typing my name in the space below, I acknowledge that I have read, accepted, and understand the McKenna Ranch Camp's safety and behavior policy."
Your answer
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