Professional Documents
Culture Documents
Campers Name:__________________
Gender __ M __ F
Check Camp
____ Trailblazer Entering or Exiting Grades 1-2 - July 11-13
Registered for:
____ Itch-ee-ow-ee Entering or Exiting Grades 3-6 July 23-27
____ Velocity Entering or Exiting Grades 7-12 June 25-29
Birth Date __________________ Last Grade Completed ________________________
Address ______________________________________________Email______________________
City____________________________ State _____ Zip ________________
Church _____________________________Pastors Name ________________________________
1. Parent/Guardians Name __________________________________________________________
Address (if different) _______________________________________________________________
Phone: home _______________ work _________________ cell ___________________________
2. Parent/Guardians Name _________________________________________________________
Address (if different) ______________________________________________________________
Phone: home _______________ work _________________ cell ___________________________
Alternate Emergency Contact ________________________________________________________
Address: ________________________________________________________________________
Phone: home _______________ work _________________ cell ___________________________
Person(s) other than parent/guardian authorized to pick up child from camp __________________
________________________________________________________________________________
Person(s) other than parent/guardian not authorized to pick up child from camp ______________
________________________________________________________________________________
Family Pack, 1st family member pays full price, additional members get $25 off.
Name of 1st family member _________________________________________________________
Bring-a-Buddy, Bring a friend whos never been to Golden Bell and one of you gets $50 off,
2nd Buddy $50 off, 3rd Buddy you come Free!
1st Friends Name _____________________________
2nd Friends Name _____________________________
3rd Friends Name _____________________________
Who gets the discount? Me/My friend.
Requested Cabin-mates (we try to match by age) ________________________________________
(must be signed before child will be allowed to ride) I, the undersigned, agree
to hold Golden Eagle Outfitters, Inc. and/or Golden Bell Camp & Conference Center harmless for any and all damages which may occur as a result of my
child participating in equine activities. I understand that under Colorado law, equine professionals are not liable for any injury to or death of a participant
in equine activities resulting from the inherent risks of equine activity, pursuant to 13-21-120 Colorado revised statutes.
Physical Exam signed by a licensed physician or nurse practitioner and dated no more than 24 months prior to camp is
required for your child to attend camp. Please send with Registration or mail copy no later than 2 weeks
prior to camp.
(OVER)
Please attach a note with any special concerns. Please notify camp if your
child is exposed to any communicable disease during the 2 weeks prior to camp.
Trailblazer Camp
Registration received by April 20:
Registration received April 21-June 15:
$ 124
$ 144
-65 Church of God Grant
-65 Church of God Grant
$ 59
$ 79
Late Registration after June 15: $179 sent directly to Golden Bell
Itch-ee-ow-ee Camp
Registration received by April 20:
Registration received April 21-June 27:
$ 229
$ 259
-85 Church of God Grant
-85 Church of God Grant
$ 144
$ 174
Late Registration after June 27: $294 sent directly to Golden Bell
Questions?
Contact Tami Mills
303-987-2415
Millsntrm4@msn.com
Velocity Camp
Registration received by April 20:
Registration received April 21-May 30:
$ 269
$ 299
-115 Church of God Grant
-115 Church of God Grant
$ 154
$ 184
Late Registration after May 30: $334 sent directly to Golden Bell
Camp Fee see above cost minus Church of God Grant
8 X 10 Camp Picture
$
Camp DVD
$
Horseback Riding (Itch-ee-ow-ee or Velocity)
$
Whitewater Rafting (Velocity Only)
$
Family Discount see 1st page registration form
$
Bring a Buddy Discount see 1st page registration form
$
T-shirt please circle size:
Youth S M L
Adult S M L XL XXL
Total
$
Deposit Paid $
Balance Due $
Mail completed form and a check made payable to Golden Bell Camp to:
The full amount is appreciated, however, $75 deposit is required and
the balance may be paid on arrival at camp. *Exception: Trailblazer paid
$ __________
__________
8.00 (optional)
__________ 15.00 (optional)
__________ 33.00 (optional)
__________ 36.00 (optional)
__________ -25.00
__________ -50.00, -100.00, free
free
__________
__________ ($75 required*)
__________
Tami Mills
542 S. Deframe
Ct.
Lakewood, CO
voice: 719-687-9561
www.goldenbellccc.org
fax: 719-687-5400
email: info@goldenbellrocks.com