2024 Adventure Camp- Wed-Thu 6/26-27 – Valley Mill Camper Forms

Overnight camping trip

Rocky Gap State Park

Trip Location: Rocky Gap State Park, 17600 Campers Hill Drive

Flintstone MD 21530

443-603-6324

Nearest Hospital:

UPMC Western Maryland

12500 Willowbrook Rd, Cumberland, MD 21502

(240) 964-7000

Trip Leaders:

Paul Diallo – 240-340-2871

Lia Johnston

Trip Details:

June 26th

The Adventure Group will arrive to camp on Wednesday am and help prepare the vehicle for the overnight trip. The group will depart from VMC at approximately 10 am and head towards Rocky Gap State Park in Flinstone, MD. We will stop at a grocery store to get food for dinner for the trip. Upon arrival at the park, we will check in to the camp site and get everything set up. Tents etc… We will then go to the lake and swim at the beach area. Around 6:00 we will walk back to our site and prepare dinner. After dinner we will have smores and hang out until it is time for bed. Lights out at approximately 9:30

June 27 th

On Thursday, the group will wake up and Paul will prepare a fire and breakfast. We will clean up our campground area and go to the lake and swim until it is time to head back to camp. Kids will be back at camp in time to catch their bus home.

Please Bring:

Reminder not to overpack, we have limited space in the van.

Tent

Sleeping Bag/Sleeping Pad

Headlamp

Personal Hygiene Items

Towel

Bathing Suit

Water Shoes

Water

Lunch

snacks

Camp Chair

Warm clothes

Hiking/ walking shoes.

To Give Permission:
By signing this form, you give permission to Valley Mill Camp to take your child off camp property to participate in the Adventure Camp Trip. If you would like your camper to attend this trip, make sure to indicate this with your digital signature. If you do not want to give permission or if they cannot attend, or if you have any questions, please call 301-948-0220.
Child's Name*
First Last
Parent's Name
First Last
Parent's Email
Parent's Phone
Emergency Contact Name*
First Last
Emergency Contact Phone*
MEDICAL RESTRICTIONS, AND ANYTHING YOU'D LIKE US TO KNOW
*
- My child has no physical, mental or medical condition that would adversely affect his/her ability to participate in the Valley Mill Camp program or that would affect his/her safety or the safety of the group. I agree to inform Valley Mill Camp of any such physical, mental, or medical condition should one develop in the future.
*
- I understand and agree that in participating in the Valley Mill Camp program or using the equipment or facilities of Valley Mill Camp or receiving the instruction of Valley Mill Camp there is the possibility of accidental or other physical injury. I agree to assume the risk of such injury and further agree to indemnify Valley Mill Camp Inc., Seneca Joint Venture and all of their agents, employees, directors, officers, affiliates, successors, and assigns (collectively “Valley Mill Camp”) from any and all liability as a result of my or my camper’s use of the facilities, equipment and instruction offered by Valley Mill Camp.
*
- 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 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.
Type Name of Signer*
First Last
Date*
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.