Booking Inquiry/Camp Application

Contact us by mail / phone

Address:
Potter's Ranch
5194 Beaver Rd
Union, KY   41091
Phone:
859-586-5475
Fax:
859-538-3749


Guest/Camp Approval Form

Your First Name (Parent/Guardian if applying for camp):
Your Last Name:
Organization:
Address:
City:
Country:
State:
Zip:
Phone:
Phone Extension:
E-mail Address:
This correspondance is about:
Thank you for your interest in your child attending day camp or another Potter's Ranch program. Completing this form does not guarantee your child's acceptance. This application simply begins the process of registering your child for camp. Once this form is complete, we will send you an email outlining the next step in our process. If you are interested in your child attending camp, but still have questions, please call us at 859-586-5475.

Previous/current Potter's Ranch camp families, please reach out to us at 859-586-5475 or info@pottersranch.org for registration information!
I acknowledge that Potter's Ranch is a private, Christian retreat center.
Name of Camper
Age of Child
Church Name What church do you attend?
Church Address
Church Phone
Church Website
Please provide the name and email address (preferred) or phone number of your pastor, an elder, church teacher, or another Christian leader who knows you and can provide a referral.
We believe in the Holy Scriptures as originally given by God, divinely inspired, infallible, entirely trustworthy, and the supreme authority in all matters of faith and conduct; creation of the world as described in Genesis; marriage as a covenant established by God to be entered into by one man and one woman; the Triune God - Father, Son, and Holy Spirit; the deity of the Lord Jesus Christ, His substitutionary atonement for sin, His bodily resurrection, and His personal, visible return to earth to reign in righteousness and glory; the Person of the Holy Spirit and His work of conviction, regeneration, and sanctification, who indwells in every believer, equipping them with gifts for service and witness; the necessity of new birth, in salvation by faith in Jesus Christ alone, and the importance of a life fully committed to the will of God in Christ; and the church as the one universal body of Christ who is the Head, called to be God's redeemed people.
I agree to the above Doctrinal Statement and to respect and abide by the Potter's Ranch Guiding Principles while on the Ranch.
(Required)
1. Profanity or inappropriate messages on clothing or otherwise displayed are prohibited. Potter's Ranch reserves sole discretion and will strive to maintain Biblical standards.
(Required)
2. Tobacco or alcohol products are prohibited on ranch property.
(Required)
3. Firearms or weapons of any kind are prohibited. Paintball markers are exempt.
(Required)
4. To ensure a safe and God-honoring environment for our guests, public displays of affection should be limited to married couples while on property. We define marriage in the Biblical sense, as one man and one woman. Similarly, couples who are dating and not yet married will not be permitted to share a cabin, unless accompanied by other family members.
(Required)
5. We honor both genders, male and female, as humans made in God's image. While we do not require a strict dress code, we do expect both males and females to dress modestly and in ways that fit their God-given gender while on Potter's Ranch property.
(Required)
Which summer camp/program are you interested in attending?
(Required)




Marital status of parent(s)?
(Required)




Who does the child primarily live with and what is their relationship to the child?
What do you hope to develop in your child this summer by attending this program?
Describe any history of behavioral or learning difficulties.
What activities does your child enjoy doing?
What are your child's needs?
What are your child's strengths?
Please add any additional comments that you feel might help us better understand your child.
How did you hear about Potter's Ranch?
(Required)