Intermediate Kayak Trip- Tuesday 6/25 – Valley Mill Camper Forms

Location: Anglers parking lot

Address: MacArthur Ave Potomac MD 20874

Group Leaders:

Liev Mitchell – 240-305-5541

Will Holman – 703-817-5740

Nearest Hospital:

Shady Grove Medical Center

9901 Medical Center Dr, Rockville, MD 20850

240-826-6000

Trip Details:

Intermediate paddlers will be introduced to class 2 whitewater In the most approachable way possible! They will be playing in the currents, practicing beginning maneuvers. We will head back to Anglers take out and head back to camp.

Trip Information:
A Kayak Trip is a trip to the Potomac river where children can work on their kayaking skills.
What to bring :
Out on the river, campers will be exposed to a lot of sun. Make sure to pack sunscreen, hat, sunglasses and anything else that may help protect from the sun. Campers will also get very wet and must wear swimsuit and clothes that are able to go in the river. Please pack lunches in a ziplock or otherwise waterproof/water resistant bag. Water shoes that will not fall off are also required 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 trip listed above. 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
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- I acknowledge that participating in Tripping Events involves exposure to risks beyond the control of Valley Mill Camp Inc, directors, and staff. I hereby agree that this trip can be dangerous and expose participants to risks and hazards including but not limited to immersion in cold water, drowning, inclement weather, slipping and falling, falling objects, and suffering injury in remote areas where help may not be readily available.
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- 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.
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- 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 use of the facilities, equipment and instruction offered by Valley Mill Camp.
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- I have carefully read this Release, Waiver, and Assumption of Risk Agreement and fully understand its contents.
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- 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
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- 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 as signer*
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Date*
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