mountain meadow ranch header

    Mountain Meadow Ranch Enrollment Form

    Click here to download the 2010 Enrollment Form pdf

     

    This is an online application.  Please fill out all fields and submit it by clicking the Submit button at the bottom of this form.  Do not attempt to print this page;  if you have difficulty with this form or prefer to fax or mail your application, please click here for a printable version.

     

    After clicking on the Submit button, you will be directed to a page confirming that your application came through and is being processed.  You will also receive an email confirmation from us upon receipt of your enrollment.  If you do not see this confirmation page or if you do not hear back from us within 24 to 48 hours, your application did not go through.  Please email us at fun@mountainmeadow.com to follow up should you not hear back from us.  Thank you, and thanks for choosing Mountain Meadow!

    NOTE: Please click here to check current enrollment status, as some sessions may already be full.


    MOUNTAIN MEADOW RANCH

    P.O. BOX 610
    SUSANVILLE, CA. 96130
    PHONE (530)257-4419
    FAX(530)257-7155
    fun@mountainmeadow.com

    APPLICATION 2010

    2010 DATES

    (Please check session)

    		 Secure Site with 128 bit encryption

    SESSION 1A June 14- June 26 ($2500 for 13 days)
    SESSION 2A July 5 - July 17 ($2500 for 13 days)
    SESSION 3A July 26 - Aug. 7 ($2500 for 13 days)
    SESSION 4 Aug. 15 - Aug. 21 ($1200 for 1 week)

     

    SESSION 1B June 14 - July 2 ($3300 for 19 days)
    SESSION 2B July 5 - July 23 ($3300 for 19 days)
    SESSION 3B July 26 - Aug. 13 ($3200 for 19 days)
    ADD RAFTING (Optional) AGES 13 & UP ONLY ($500)
          Available Sessions 1, 2 & 3 only

     

     

    A CONFIRMATION NOTICE WILL BE MAILED UPON ACCEPTANCE
    Enrollment subject to conditions of enrollment as set forth below.

    Camper #1
    Name: Handle/Nickname: Girl Boy
    Birth Date: Age (at camp time): Grade (Fall 2010):
    School: This will be your year at Mountain Meadow Ranch

    Camper #2
    Name: Handle/Nickname: Girl Boy
    Birth Date: Age (at camp time): Grade (Fall 2010):
    School: This will be your year at Mountain Meadow Ranch

    Camper #3
    Name: Handle/Nickname: Girl Boy
    Birth Date: Age (at camp time): Grade (Fall 2010):
    School: This will be your year at Mountain Meadow Ranch

    Parent or Guardian
    Father: Mother: Family E-mail
    Camper Lives With:      Father   Mother   Both Parents    50/50   Guardian Name:


    Camp Correspondence Mailing Address
    Street: City:
    State or Province:   Zip/Postal Code:   Country(if outside the USA):
    Home Telephone: () Cell Phone: () Fax Number: ()
    Parent's Occupation: Work Phone: ()    
    Names and ages of siblings:
    EMERGENCY CONTACT IN PARENT'S ABSENCE:
    Name: Relationship: Phone: ()

    How did you hear about Mountain Meadow Ranch? If you found us on the internet, please specify where.
    Names and addresses of friends you wish us to send info to:
    Name: Address: City: State: Zip:
    Name: Address: City: State: Zip:
    Name: Address: City: State: Zip:
    Please send me info packets to share with friends.

    MY METHOD OF
    PAYMENT FOR
    DEPOSITS:    		 Check or Money Order - U.S.
    Funds in the amount of $     		SESSIONS 1B, 2B & 3B TUITION ... *$3300 (5% discount on 2nd child)
    SESSIONS 1A, 2A & 3A TUITION ... *$2500
    SESSION 4 TUITION ... *$1200
    RAFTING EXCURSION (Optional) ... ADD *$500 (AGES 13 & UP)
    BALANCE MUST
    BE PAID BY
    CHECK    		 Visa MasterCard
    Visa & MasterCard for deposit only.

    BALANCE OF TUITION MUST BE PAID BY CHECK, BEFORE JUNE 1ST 2010 TO SECURE CAMPER'S SPACE.

    DEPOSIT (Required to hold space): $500 per child per session
    Card Number: Cardholder's Name:
    Exp Date:   /    V-Code:  Cardholder's Signature:

    Tuition includes everything except travel, medical expenses & spending money (Los Angeles and San Francisco Bay Area families please see the travel section above for more info).  There will be no refunds for cancellations, absences, withdrawals or dismissal from camp after MAY 1st.

    * Tuition subject to change. Check website or call for current rates. (Tuition secured upon enrollment)


    THE FOLLOWING INFORMATION IS NECESSARY TO COMPLETE REGISTRATION

    MOUNTAIN MEADOW RANCH REQUIRES EACH CAMPER TO HAVE A HEALTH AND ACCIDENT POLICY
    Health & Accident Insurance? Yes No Name of Policy Holder:
    Insurance Company: Policy or Group #:

    Insurance Co. Address:     City:     State/Province:     Zip:     Country:

    Insurance Co. Phone Number:

     

    CONDITIONS OF ENROLLMENT

    I agree and/or acknowledge that:

    1. My child will abide by the rules and regulations set forth by Mountain Meadow Ranch, hereafter referred to as MMR for the health, safety, and welfare of the campers. MMR reserves the right to dismiss a camper whose conduct or influence, in the opinion of MMR, is unsatisfactory or in the opinion of MMR is not in the best interest of the camp. In such event, THERE SHALL BE NO REFUND of any part of the camp fee. MMR reserves the right to refuse acceptance. Any damages to MMR property, staff property or other campers property as a result of my child's actions is my financial responsibility. If my child breaks or damages something beyond normal ware, I will pay for it.
    2. It is understood that the parent/guardians of campers enrolling in MMR, are obligated to inform the camp AT THE TIME OF THIS APPLICATION, of any physical, psychological, emotional, or behavioral problems, difficulties or challenges the child has whether requiring professional treatment or not which could potentially have a negative effect on his/her camp experience or which might potentially have a negative effect on other campers camp experience.
    3. All camping programs are planned in advance of opening day (including purchase of supplies, equipment, and hiring of staff based on confirmed camper reservations), therefore after May 1st, no allowance, refunds or rebates will be made for cancellations, withdrawls, late arrival, early departure for any reasons or should he/she be dismissed from camp due to misconduct, HOMESICKNESS, or for any physical or behavioral problems and a $150 service charge will be deducted for all cancellations before May 1st.  In the event of accident or illness, the camp and the parent, AT THE CAMP'S SOLE DISCRETION, may share in the unused tuition 50% each.  Notice of cancellation must be made in writing.
    4. MMR is not responsible for articles of clothing or personal belongings lost or damaged by fire, theft, laundry, etc. (No valuable jewelry, tech devises such as CD players, cell phones, computer devices or walkmans at camp) All techno devices brought to camp will be mailed home C.O.D. and a $20. handling fee will be charged to the campers account.
    5. In case of emergency, I hereby give permission to MMR to hospitalize and to treat my child as necessary. I understand that all expenses not covered by my health insurance are my sole responsibility.
    6. A copy of my insurance claim form and the MMR Health Form signed by my child's physician must be submitted to MMR at least 2 weeks prior to camp arrival. (This health form and additional information for camp preparation will be sent to the camper by early May)
    7. Any pictures, recordings, video footage, any images moving or still and/or writings will belong to MMR and may be used for advertising and promotion.
    8. If any action is brought based upon this agreement, the prevailing party shall be entitled to their reasonable attorney's fees.
      PLEASE NOTE: The management of MMR will always conduct their camp program with the highest level of supervision and trained personnel. However, camp activities involve a certain amount of risk and parents need to be aware of this kind of exposure. We ask our parents to read the following statement carefully and initial. Please call us if you have any questions.
    9. ASSUMPTION OF RISK AND RELEASE OF LIABILITY...I AM AWARE THAT CERTAIN CAMP ACTIVITIES (SUCH AS BUT NOT LIMITED TO, THE CHALLENGE COURSE, WATER SKIING, HORSEBACK RIDING, MOUNTAIN-BIKING, WHITE WATER RAFTING, CAVING ETC.) ARE INHERENTLY DANGEROUS. I VOLUNTARILY CONSENT TO MY CHILD'S PARTICIPATION IN THESE ACTIVITIES WITH FULL KNOWLEDGE OF THE DANGERS INVOLVED AND I ACCEPT ALL RISKS OF INJURY TO MY CHILD. FURTHER I HEREBY RELEASE AND AGREE TO INDEMNIFY MMR, ITS PRINCIPALS, AGENTS AND EMPLOYEES FROM ALL LIABILITY THAT I OR MY CHILD MAY HAVE FOR INJURY RESULTING FROM MY CHILD'S PARTICIPATION IN SUCH ACTIVITIES.
      PLEASE INITIAL:
    10. DISPUTE RESOLUTION: This agreement, and any claim arising out of or related to it, shall be governed by and construed under California law. The parties further agree to submit to the nonexclusive jurisdiction of California courts, and to bring any claim in California. Parent/legal guardian and Mountain Meadow agree that any claims arising out of or related to this agreement shall be determined by arbitration administered by the American Arbitration Association under its commercial arbitration rules, such arbitration to be held in San Francisco, California and governed by the substantive law of California, and further agree that judgment on the arbitration award may be entered in any court having jurisdiction thereof.

    I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS IN GENERAL AND SPECIFICALLY, THAT IT IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND MMR AND I SIGN IT OF MY OWN FREE WILL.

     

    X
    PARENT OR LEGAL GUARDIAN
    DATE     		X
    PARENT OR LEGAL GUARDIAN
    DATE

    * Please print the next page for your records.

    NOTICE!! A COMPLETE ENROLLMENT FORM IS REQUIRED TO SECURE YOUR CHILD'S SPACE!!

     

    NOTICE: By typing your name(s) in the signature space(s) above, you
    agree that your typed name(s) will be considered your legal signature(s).

    back to top ↑