Online Application

Please fill out the form below. You must also print out and fill out the parents affidavit and doctors affidavit and parents questionnaire and bring them with you to camp or mail them with your $100 deposit.

Camper Information
ONLY ONE SESSION FOR 2013. Space is limited. Not all applicants will be able to attend the Ranch. If your application is not accepted this year we would encourage you to apply again next year.
Name
FirstLast
Birthday
School
Grade
Shirt Size*
Youth Sizes
Email*
Ranch Session Desired*
Father's Information
Name
FirstLast
Father's Email
Home Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Is This Your Mailing Address?*
- Yes
- No
Mailing Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone
Cell Phone
Mother's Information
Name
FirstLast
Mother's Email
Home Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Is This Your Mailing Address?*
- Yes
- No
Mailing Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone
Cell Phone
How did you hear about the ranch?
Names and ages of brothers and sisters:
Camper Questionnaire and Agreement - Summer 2013
The remainder of this Camper’s Application is to be filled out by the applicant him/herself. Parents must not fill out this section of the application for the applicant.
What are some things you do well? *
What is the hardest thing that you have done during the past year? *
Do you have friends and/or relatives planning on attending the Ranch with you? If so, list their names:
Are you willing to come to the Ranch even if the applications for your friends are not accepted?
- Yes
- No
Are you willing to accept whatever yurt assignment is given you even if it is not with your friends?
- Yes
- No
Are you willing to work cheerfully every day at the Ranch at whatever assignment is given to you?
- Yes
- No
Are you willing to go on the backpack and overnight hikes even though they will be hard?
- Yes
- No
Will you control your temper and language while at the Ranch so that you don’t swear or fight?
- Yes
- No
Will you agree to not deface any Ranch property and to treat others with respect?
- Yes
- No
Do you commit to staying for the duration of the ranch session?
- Yes
- No
Other than the ranch do you have other activities planned for the summer?
- Yes
- No
What are those activities?
What are some of your favorite hobbies, activities or special interests?
Write a paragraph about why you want to come to the Ranch, what you hope to get out of the experience, and what you think your contribution to the Ranch and others will be:
For Parents
We want to have ranch participants who want to be here. Please do not pressure your child in any way to complete this application. Please complete the parents form below. You will need to send in a separate Doctor's Affidavit and a insurance card before camp starts. You will need to make a non-refundable (unless your application is not accepted) $100 deposit at the time of application to be considered. The full tuition is due two weeks before the session starts. Only complete applications will be considered. There is a checklist at the end of the application, make sure to fill in the boxes to insure completeness
Scholarships
- Please check box to be considered for a scholarship.
Will your child require free transportation between Salt Lake City, Orem, or Spanish Fork and the Ranch?
- Yes
- No
Do you authorize your child to participate in rock climbing and rappelling?
- Yes
- No
Why are you interested in having your child participate in the Birch Creek program? What do you hope he/she will gain from the experience?
How would you characterize your current relationship with your child?
Please describe your child's health: General health? Major Illness? Past injuries? Treatment for ADD, depression, anxiety, eating disorders, other mental illness?
Please describe any limitations to your child's physical or social abilities.
Is there additional information to be considered in evaluating your child's application?
Provide insurance info below. Include carrier name, policy number, carrier's address and phone number, name of employer providing insurance, insured employee's name and parent's date of birth. Be sure to also send a copy of the insurance card.
I understand that the purpose of Birch Creek Ranch is, among other things, to provide a challenging experience for my child. I understand that while my child is at Birch Creek, that he or she may feel tired, homesick, or challenged physically or emotionally. I understand that the length of the program is central to the experience. I commit to encouraging my child to participate to the fullest in Birch Creek's programming. I understand that by sending my child to Birch Creek I am committing to encourage him or her to participate in the programs, even though they may prove difficult.
- Please check box to indicate that you understand the above statement and that you are willing to make those commitments.
Please provide household income information to help us understand our demographics, apply for grants, and for scholarship consideration. Select one:
Please check box to approve this application and agree that the provided information is true an accurate.
- Check here
Your completed application must be submitted no later than APRIL 15, 2013 In order for application to be complete it must include all items listed below. Please complete the following items and mail to the address below:
1. Camper Application / Camper Questionnaire and
2. Agreement (submitted online)
3. Parent Questionnaire
4. Parent Affidavit and Agreement
5. Recent Doctor’s Affidavit
6. Current tetanus shot
7. Insurance Card Photocopy
8. Deposit ($100)
9. Recent Photo
Mail to: Birch Creek Ranch PO Box 423 Spring City, UT 84662
Captcha
Parent Affidavit and Agreement
Doctor´s Affidavit
Pay Tuition on the payment page
We're having trouble with processing payments from this form. Please pay from the Donation/Payment tab on the website. Thanks.
Tuition/Deposit*
- Pay Deposit Now ($100)
- Pay Now FULL Tuition ($1,500 INCLUDES DEPOSIT))
Total
$0.00

Online Application

Online Application

Camper Information

Father's Information

Mother's Information

Camper Questionnaire and Agreement - Summer 2013

For Parents

Pay Tuition on the payment page