2024 Spring Registration – Valley Mill Camper Forms

Select Session(s)*
- MCPS Spring Break Camp -3/25 – 3/29 $600 (includes $100 Reg Fee)
- DCPS Spring Break Camp -4/15 – 4/19 $600 (includes $100 Reg Fee)
Notes
Camper Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Home Phone*
Date of Birth*
Month
Day
Year
Age*
Grade Next September*
School Name*
Has your Camper attended Valley Mill Camp before?*
How did you hear about Valley Mill Camp?*
Buddy Request
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 CAMPERFORMS@VALLEYMILL.COM*
- By checking here you agree that you have read and understood the statement above.
2024 Refund Policies
Upon registration, the first $50 of your registration fee/tuition is non-refundable to cover the costs of processing, database, and staffing fees associated with registration.*
- By checking here you agree that you have read and understood the statement above.
I understand that in registering my Camper(s) I am purchasing a spot for the specific dates chosen. There are no "make up days", refunds or credits for days absent.*
- By checking here you agree that you have read and understood the statement above.
I understand and agree to abide by all of the policies outlined above.*
- By checking here you agree that you have 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 have 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 have 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 have 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 have read and understood the statement above.
Name of Signer – Parent or Legal Guardian*
First Last

2024 Refund Policies