Family Record Form 2025/26
Please fill out in full for Summer camp registration
Email *
Parent or Guardian #1 name  *
Home, work and/or cell number (this is the best way to reach parent #1) *
Physical Address and Mailing address for parent #1 *
For parent #1 (if applicable)
1. Employer
2. Employer address
3. work hours
4. Phone number if different from above
 *
Parent or Guardian #2 name  *
Home, work and/or cell number (this is the best way to reach parent #2) *
Physical Address and Mailing address parent #2 *
For parent #2 (if applicable)
1. Employer
2. Employer address
3. work hours
4. Phone number if different from above
Emergency Contact -- Please include a contact that is not already listed. *
Authorized Pick Up - List any one name AND phone number of who can pick up your child, you can add or take away contacts at any time. *
Household Medical Information
Physician, phone number and address
 *
dentist, phone number and address
 *
Hospital of choice, Phone Number and Address
 *
Health insurance company
 *
Member ID/Policy Number *
Child #1 info 
Name
 *
Gender *
What grade will they be entering in fall 2025? *
Date of Birth *
MM
/
DD
/
YYYY
Child's Physical Address (list all that apply) *
Does this child have any health concerns? (Medications, chronic conditions, or disabilities) we should know about in order to facilitate a safe and successful summer? Please describe. *
List known allergies
List any prescription Medications *
Will we need to administer any medications? *
Authorization for Emergency Medical care. 
By typing your name below you agree to this statement. " I hearby give permission to the Town of Oak Creek's School Age Child Care Program and Recreational staff to secure emergency/urgent medical and/or surgical treatment for my child/children while in their care. All expenses of such care will be accepted by the parent(s) or legal guardian, including fees for an ambulance. I realize attempts to reach the primary and/or secondary guardian listed above will be made prior to any decisions, unless a life-threatening situation is at hand or circumstances do not allow.
 *
Child #2 info 
Name
 *
Gender *
What grade will they be entering in fall 2025? *
Date of Birth *
MM
/
DD
/
YYYY
Child's Physical Address (list all that apply) *
Does this child have any health concerns? (Medications, chronic conditions, or disabilities) we should know about in order to facilitate a safe and successful summer? Please describe. *
List known allergies *
List any prescription Medications *
Will we need to administer any medications? *
Authorization for Emergency Medical care. 
By typing your name below you agree to this statement. " I hearby give permission to the Town of Oak Creek's School Age Child Care Program and Recreational staff to secure emergency/urgent medical and/or surgical treatment for my child/children while in their care. All expenses of such care will be accepted by the parent(s) or legal guardian, including fees for an ambulance. I realize attempts to reach the primary and/or secondary guardian listed above will be made prior to any decisions, unless a life-threatening situation is at hand or circumstances do not allow.
 *
Do you need additional space to add more children? If Yes, email recreation@townofoakcreek.com  *
Payment information.
I understand that the registration fees will be collected once per year, and include all recreation activities (youth and adult)

In-Town Resident:

$150/family (2 adults and all children 18 and under in the household)

$ 40/individual

Out-of-Town Resident:

$200/family (2 adults and all children 18 and under in the household)

$ 55/individual


Please mark which option you would like to do for this year. (Feb 2025-Feb 2026)

 *

Summer camp requires a credit card on file to process automatic payments to be charged on Mar 12 (registration fee), April 28, May 26, and Jun 16th, 2025. You will be notified of the charge amounts at the time of confirmation.

Clear selection
Credit Card you wish to have on file. 
1.Card Number
2. Expiration date
3. Security Code
 *
By typing your name below you are authorizing the Town of Oak Creek to process these payments. *

PERSONAL RELEASE LIABILITY AGREEMENT

 

The undersigned acknowledges that this activity is a potentially dangerous activity involving RISK OF PERSONAL INJURY, DEATH AND PROPERTY DAMAGE. I expressly understand and agree that neither the Town of Oak Creek, CO, a municipal corporation, nor any of their officers, agents, volunteers, assistants, or employees shall be held responsible or made the subject of any claim seeking to assess damages or liability for or arising from personal injury or property damage or loss of any other sort to myself or other person in whose behalf this form is now signed as a result of actual or proposed participation in the above named program and I hereby agree to indemnify and hold the Town of Oak Creek, their officers, agents, volunteers, assistants, or employees harmless on account of any such claim.­­­­­­­­­­­­­­­­­

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I give permission for my child/charge (“child”) or children and/or myself to be transported in a motor vehicle driven by staff or volunteers of The Two of Oak Creek’s School aged child care program, and The Town of Oak Creek (TOC). 

I understand that all applicable laws regarding riding in a motor vehicle and directions provided by the driver and/or other adult volunteers must be followed.

I have read and understand that:

1.I and/or my children will be traveling in a motor vehicle driven by an TOC staff or volunteer and we are to wear our safety belts (or be buckled into a car seat); while traveling.

2.We are expected to respect each other, the vehicles we ride in, and the people we travel with during the trip;

3.We are to remain in our seats and not be disruptive to the driver of the vehicle.

4.Riding in a motor vehicle may result in personal injuries or death from wrecks, collisions or acts by riders, other drivers, or objects; and

5.We are not required to participate in TOC programming, but grant permission, despite the possible risks.

6.I recognize that by participating in this activity, as with any activity involving motor vehicle transportation, we may risk personal injury or permanent loss.

I hereby attest and verify that I have been advised of the potential risks, that I have full knowledge of the risks involved in this activity, and that I assume any expenses that may be incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses.

I hereby give permission for my child(ren)or myself to go on all scheduled trips AWAY FROM THE PREMISES of the program, in the company of a qualified adult, whether on foot or by vehicle, using Oak Creek Parks & Recreation provided transportation when needed. I also give my permission for my child(ren)or self  to be transported by a staff member in a licensed vehicle in the case of an emergency.

 


 

 *
Required
By typing my name in the box below, I am signing this Agreement electronically. I agree my electronic signature is the legal equivalent of my manual signature on this Agreement. I consent to be legally bound by this agreement's terms and conditions.

Participant (if over 18)/Parent/ Guardian Electronic Signature 
 *
Please contact Alissa Hill is you need to make other arrangements 970-200-4149, recreation@townofoakcreek.com
The below waivers refer to all children listed in the previous pages. Please read and initial the following.
1.I understand that Oak Creek Parks & Recreation needs on file a copy of an up-to-date, current IMMUNIZATION RECORD for each child prior to their first day at the afterschool and/or summer camp programs. I warrant that the participant(s) do not have any communicable diseases, and that I will report any exposure of my child(ren) to any communicable diseases to a supervising employee of the program (including strep, measles, chicken pox, common cold and influenza.)

 ***Current immunization records for each child must accompany this admission form. *** 

 *
2.I have received and have read the current HANDBOOK (not required for Age 12+ participants). I hereby agree to comply with the rules & regulations of the programs as stated in the Handbook regarding tuition, registration, discipline, attendance, health, clothing and other items as specified.
3.  I understand the following Cancellation/Refund/Household Credit Policy : (Further details in the Handbook.) *
4. Registration /Application fee is non-refundable. *
5. No refund for school closings, days off, sick days or family vacation days. *
6.  Absences cannot be credited or refunded.  *
7.  A 14 day written notice to add, drop or change a child's schedule is required. *
8.  I hereby give permission for my child(ren) to go on all scheduled trips AWAY FROM THE PREMISES of the program, in the company of a qualified adult, whether on foot or by vehicle, using Oak Creek Parks & Recreation provided transportation when needed. I also give my permission for my child(ren) to be transported by a staff member in a licensed vehicle in the case of an emergency.  *
9. I understand that I am required to provide SUN BLOCK AND INSECT REPELLENT for my child(ren) at the camp. If my child(ren) comes to camp without these items, I understand that camp personnel will provide Broad Spectrum SPF 50 Rocky Mountain Sunscreen, Coppertone SPORT Sunscreen Spray SPF 70,
 and OFF! Deep Woods with25% DEET !  for use on my child(ren), and I understand that they may not protect as well as my brands. I know that there are possible adverse skin reactions to certain sun protection lotion and insect repellants, and my child(ren) are not allergic to these specific brands. *
10.  I expressly understand and agree that neither the Town of Oak Creek, CO, a municipal corporation, nor any of its officers, agents, volunteers, assistants, or employees shall be held responsible or made the subject of any claim seeking to assess damages or liability for or arising from personal injury or property damage or loss of any other sort to myself or the people in whose behalf this form is now signed as a result of actual or proposed participation in the above-named program and I hereby agree to indemnify and hold the Town of Oak Creek, its officers, agents, volunteers, assistants, or employees harmless on account of any such claim.  *
11. I agree to be reachable via phone, email and text messages for communication about my child and or camp details. I will provide updated contact information as needed. *
12. I understand any electronics (for example: games, phones, tablets, watches, etc.) are not allowed at camp and will be held by a counselor for safe keeping until pick up. *
13. **OPTIONAL** I hereby give permission to the Town of Oak Creek to use my child(s) name and PHOTOGRAPHIC LIKENESS in all forms and media for advertising, trade, and any other lawful purposes, and forfeit all compensation for use. (By NOT authorizing this line, your child(ren) will NOT be allowed in pictures.
By typing my name in the box below, I am signing this Agreement electronically. I agree my electronic signature is the legal equivalent of my manual signature on this Agreement. I consent to be legally bound by this agreement's terms and conditions.

Participant (if over 18)/Parent/ Guardian Electronic Signature 
 *
A copy of your responses will be emailed to .
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