Camp Registration II

This field is for validation purposes and should be left unchanged.

Camper Registration

To complete the registration parents must upload the child's 1. SIGNED copy of a physical examination performed within the preceding 24 months of the camp dates, 2. an official Colorado Department of Public Health and Environment (CDPHE) Certification of Immunization, and 3. a copy of child's health insurance card front and back. If you do not have the required documents at the time of registration, you may email them separately to education@rmfu.org. Questions? Please contact Bri Sorensen at 720-408-4091 or via email at bri.sorensen@rmfu.org

Which camp will your child attend?(Required)

Junior Camp: Grades 2- 6

Senior Camp: Grades 7 - 12

Camp Registration Options(Required)

$300: RMFU Member

$345: Nonmember (includes a $45 supporting membership)

$425: Nonmember who does not wish to purchase Supporting Membership

RMFU Membership Number

Total

About the Camper

One form must be completed for each camper.

Camper Name(Required)

First Last

Gender(Required)

Male

Female

Camper Birthdate(Required)

Last Grade Camper Completed

Camper Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Camper Phone

Camper Email

Parent/Guardian 1: Information

Name(Required)

First Last

Parent 1: Cell Phone(Required)

Parent 1: Email(Required)

Parent 1: Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent 1: Employer Name(Required)

Parent 1: Employer Phone(Required)

Parent/Guardian 2: Information

Parent 2: Name

First Last

Parent 2: Email

Parent 2: Cell Phone

Is Parent 2 Address the same as Parent 1?

Yes

No

Parent 2: Address

Street Address Address Line 2 City State ZIP Code

Parent 2: Employer

Parent 2: Employer Phone

Emergency Contact: Information

If parent(s) not available in an emergency, notify this person.

Emergency Contact: Name(Required)

First Last

Relationship to Camper(Required)

Emergency Contact: Cell Phone(Required)

Emergency Contract: Address(Required)

Street Address Address Line 2 City State ZIP Code

Transportation

Parents are responsible for transportation to and from camp. Please list a secondary pick-up/drop-off person that is someone other than a parent.

Secondary Pick-Up/Drop-Off Person(Required)

First Last

Relationship(Required)

Cell Phone(Required)

Is there a person the camper is NOT allowed to leave with?(Required)

Yes

No

Name

First Last

If there is someone camper may not leave with, please give the name here.

Medical Information and Documentation

Please note for the following fields: uploaded documents will NOT save if you click "save and continue later." If you do not finish the application in one sitting, you will need to upload the documents at the very end before submitting the application.

Is the camper covered by family health insurance?(Required)

Yes

No

Upload a copy of the FRONT of camper's health insurance card.

Max. file size: 50 MB.

Upload a copy of the BACK of camper's health insurance card.

Max. file size: 50 MB.

Upload official Colorado Department of Health and Environment Certificate of Immunization.

Max. file size: 50 MB.

When was the date of camper's last physical exam?(Required)

Physical Examination: must be signed by your doctor and performed within the preceding 24 months of the camp dates. A link to a blank copy of this form can be found at the top of this webpage.

Payment

If paying by credit card, please enter information below. If paying by check, please remit payment to Rocky Mountain Farmers Union Foundation, 7900 E. Union Ave., Suite 200, Denver CO 80237.

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Total