Mill Valley Ranch

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    Mill Valley Ranch

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    Roundup 656 Adventure Camp

    Date: 07-Jan-2018

    Booking

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    Parent/Guardian/Agency Name




    CONTACT DETAILS









    RANCHERS DETAILS









    EMERGENCY CONTACT DETAILS






    ROUNDUP DETAILS






    MEDICAL DETAILS - Does your child suffer from any of the following?

    ASTHMA
    EPILEPSY/SEIZURES
    SKIN PROBLEMS
    INTELLECTUAL DISABILITY
    ANY OTHER MEDICAL CONDITION
    BED-WETTING
    HAYFEVER
    KIDNEY DISEASE
    DIABETES
    HEADACHES
    ALLERGIES
    PHYSICAL DISABILITY
    NONE
    EAR INFECTIONS
    HEART DISEASE












    MEDICAL INSURANCE DETAILS








    DIETARY DETAILS


    CHICKEN
    FISH
    BOTH




    THANK YOU FOR YOUR ATTENTION TO THESE QUESTIONS

    Before submitting this Form, please take a minute to check that ALL questions have been answered — especially the MEDICARE No. — and that the RANCHER and PARENT/GUARDIAN (if rancher is under 18 years old) read and agree fully to the below details.

    NOTE: BY SUBMITTING THIS APPLICATION BOTH PARENT/GUARDIAN AND RANCHER IRREVOCABLY CONFIRM THEY HAVE READ AND ARE FULLY ACCEPTABLE OF ALL MILL VALLEYS TERMS AND CONDITIONS.

    All Ranchers are expected to abide by MVR rules whilst on camp. MVR has a three strike policy when dealing with unacceptable behaviour on camp. If the Rancher is not abiding by Ranch rules they will first be spoken to by Ranch Staff. If their behaviour does not improve after having had it addressed the parents/guardian of the Rancher will be notified of the issue. In the event that after consultation with parents/guardians the Rancher’s behaviour shows no sign of improvement, the Rancher will be asked to leave the camp. Physical violence will in no way be tolerated.

    In submitting this form, I (the Parent/Guardian) certify that all the necessary information has been provided. I grant permission for my child to participate in the camp and in the case of accident or illness, permission is given for any necessary medical attention and I agree to accept any charges. I understand that if my child displays behaviour that is inappropriate in a camp environment I will be contacted and am prepared to organise for my child to be picked up from camp if the issue is unable to be resolved.

    In submitting this form, I (the Rancher) agree to abide by the Ranch rules. This includes attending all programmed activities such as meal times, activities and Chapel. I understand that unacceptable behaviour such as failing to abide by the Ranch rules, bullying in any form, violence or abuse of any kind, will result in my parents/guardian being called and may result in me being sent home.

    NO SMOKING OR ALCOHOL ALLOWED AT CAMP

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