Adventure Camp- Wednesday 8/13 – Valley Mill Camper Forms

“Difficult Run” Trail

We are planning on Hiking a trail called Difficult run at Great Falls Park so we can eat lunch while viewing the water falls. We will then create a loop using the Swamp trail to go back to the beginning of the Difficult run Trail and finish the hike. It will be about 4 miles of hiking in total. Please make sure your camper has a lunch, refillable water bottle, and appropriate clothes and shoes.

What to pack:

Lunch

Bug spray

Small backpack

Sunblock

Hat

Shoes for hiking

Refillable Water

Nearest Hospital:

Reston Hospital Center

1850 Town Center Pkwy, Reston, VA 20190

Trip Leaders:

Paul Diallo – 240-340-2871

Elea Breeden – 443-517-3513

Trip location:

8801 Georgetown Pike, McLean, Va 22102

Company
This field is for validation purposes and should be left unchanged.
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