2021 Summer Registration – Valley Mill Camper Forms

Due to group size restrictions dictated by the COVID-19 pandemic, Valley Mill Camp is now fully enrolled for the 2021 Summer Season

We invite you to enroll your camper(s) if you would like to be placed on our Waitlist, but do NOT send us the registration fee. If a place becomes available for your camper(s), we will contact you with next steps.

Thank You!
Select Session(s)*
- Season (MCPS) 6/21-8/20 - $5400($600 Reg Fee)
- Season (DCPS) 6/28-8/20 - $4800($600 Reg Fee)
- 1st Session (MCPS) 6/21-7/23 - $3000($300 Reg Fee)
- 1st Session (DCPS) 6/28-7/23 - $2400($300 Reg Fee)
- 2nd Session: 7/26-8/20 $2400 ($300 Reg Fee)
- A Session: 7/26-8/6 $1200 ($300 Reg Fee)
- B Session: 8/9-8/20 $1200 ($300 Reg Fee)
- 1st + A(MCPS): 6/21-8/6 $4200 ($600 Reg Fee)
- 1st + B(MCPS): 6/21-7/23, 8/8-8/20 $4200 ($600 Reg Fee)
- 1st + A(DCPS): 6/28-8/6 $3600 ($600 Reg Fee)
- 1st + B(DCPS): 6/28-7/23, 8/8-8/20 $3600 ($600 Reg Fee)
- 10th Week: 8/23-8/27 $600 ($200 Reg Fee)
Notes
Camper Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Home Phone*
Date of Birth*
MM
DD
YYYY
Gender*
Age*
Grade Next September*
School Name*
Has your Camper attended Valley Mill Camp before?*
How did you hear about Valley Mill Camp?*
Buddy Request
T-Shirt Size*
Parent #1*
First Last
Parent #1 Email*
Parent #1 Cell Phone*
Parent #1 Work Phone*
Parent #2 Name*
First Last
Parent #2 Email*
Parent #2 Cell Phone*
Parent #2 Work Phone*
Emergency Contact Name*
First Last
Emergency Contact Phone*
Date of Tetanus Shot*
Health Information*
Photo Permission - Valley Mill Staff takes photos of campers to include on our Website, Social Media and occasionally Camp Literature.(No Camper is ever identified by Name) Please Click the response below to indicate your preference*
- Yes, I give my permission to use photos including my child on Valley Mill's Websites, Social Media and Camp Literature
- No, I do not give my permission to use photos including my child on Valley Mill's Websites, Social Media and Camp Literature
Privacy Permission - Is it ok to share your phone number and email with other parents in your child's group for the purpose of party and playdate invitations*
- Yes, I give my permission to share my contact information with other parents
- No, I do not give my permission to share my contact information with other parents
YOUR APPLICATION WILL NOT BE CONSIDERED UNTIL THIS FORM IS SIGNED (BELOW), SUBMITTED (BELOW) AND REGISTRATION FEE IS RECEIVED WITHIN 72 HOURS OF YOUR ONLINE SUBMISSION. A CONFIRMATION EMAIL WILL BE SENT TO YOU WITH A COPY OF YOUR APPLICATION, IF YOU DO NOT RECEIVE A CONFIRMATION EMAIL IT IS YOUR RESPONSIBILITY TO REPORT IT TO MELINDA@VALLEYMILL.COM*
- By checking here you agree that you read and understood the statement above.
Refund Policy, Registration Fee: The registration fee of $300.00 per session, which is applied to camp tuition, is nonrefundable after March 1. If you cancel a full session after March 1 the entire registration fee is nonrefundable and if you cancel part of a session, $100.00 of your registration fee, per canceled week, will be nonrefundable after March 1.
- By checking here you agree that you read and understood the statement above.
Refund Policy, Tuition: Valley Mill Camp's Tuition Refund Policy provides against tuition loss in the event of extended absence due to illness. This illness needs to be confirmed by a physician in writing and with a recommendation that your camper withdraw from camp. No refund will be made for the first five days of consecutive absence. Non-consecutive days of absence cannot be accumulated for refund or credit. Other than absences of more than 5 consecutive days, verified by a physician, there are no other refunds provided.*
- By checking here you agree that you read and understood the statement above.
Refund Policy, COVID19: I understand that in the event of mandated closure by any governmental agency due to safety concerns with the COVID-19 Pandemic, any tuition or fees paid will be credited towards the 2022 Season. No refunds will be offered.*
- By checking here you agree that you read and understood the statement above.
Exchanging Weeks: If a camper is unable to attend one or more weeks in any session, those weeks can be made up in another session, DEPENDING UPON AVAILABILITY. Exchanges made after May 1 will incur a $100.00 per week fee.*
- By checking here you agree that you read and understood the statement above.
COVID 19
I agree to monitor my camper(s) for any symptoms related to COVID-19 for a period of at least 2 weeks prior to arriving at Camp, and to report any such symptoms before arriving at Camp*
- By checking here you agree that you read and understood the statement above.
I have discussed participation in Valley Mill Camp with my camper's Healthcare Provider including considerations related to the risk of COVID-19*
- By checking here you agree that you read and understood the statement above.
Coronavirus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a mean to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in Valley Mill Camp’s programs or accessing Valley Mill Camp’s facilities could increase the risk of contracting COVID-19. Valley Mill Camp in no way warrants that COVID-19 infection will not occur through participation in Valley Mill Camp programs or accessing Valley Mill Camp facilities.*
- By checking here you agree that you read and understood the statement above.
In consideration of my camper's participation in Valley Mill Camp I agree to release and on behalf of myself, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE Valley Mill Camp, its officers, directors, employees, volunteers, agents, representatives and insurers (“Releasees”) from any causes of action, claims, or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which I, my heirs, representatives, executors, administrators and assigns may have, now or in the future, against Valley Mill Camp on account of personal injury, property damage, death or accident of any kind, arising out of or in any way related to the use of Valley Mill Camp facilities/equipment or participation in Valley Mill Camp programs whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to the negligence of Releasees.*
- By checking here you agree that you read and understood the statement above.
In consideration of my camper's participation in Valley Mill Camp, I, the undersigned participant, agree to INDEMNIFY AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way related to my camper's Valley Mill Camp participation..*
- By checking here you agree that you read and understood the statement above.
I hereby certify that I have full knowledge of the nature and extent of the risks inherent in Valley Mill Camp participation and that I am voluntarily assuming said risks. I understand that I will be solely responsible for any loss or damage, including personal injury, property damage, or death, I sustain while participating in Valley Mill Camp and that by signing this agreement I HEREBY RELEASE Releasees from all liability for such loss, damage, or death. I further certify that my camper is in good health and that he/she has no conditions or impairments which would preclude safe participation in Valley Mill Camp*
- By checking here you agree that you read and understood the statement above.
Electronic Signature Agreement*
- By checking the above checkbox, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.
I agree that I am the Parent or Legal Guardian of the Camper named above, that I am 18 years of age or older, and that I have the legal authority to grant this permission to Valley Mill Camp Inc*
- By checking here you agree that you read and understood the statement above.
Name of Signer - Parent or Legal Guardian*
First Last

COVID 19