Valley Mill Fall Events – Valley Mill Camper Forms

Registration Form

Summer is over, but it doesn’t mean the fun has to end. Valley Mill’s Fall 2019 Calendar is full with activities for everyone.

- Valley Mill is offering Holiday Camp, Adventure Camp and Weekend Kayak Classes. Parents are welcome to sign up for one ore more events. Click the check box next to the event you would like your camper to participate in. You can select more than one.
- Fall Events*
  - 11/11 Holiday Camp $110.00 DCPS
- Notes:
- Camper Information
- Camper's Name*
  First Last
- Address*
  Street Address City State / Province / Region ZIP / Postal Code
- Home Phone*
- Date of Birth*
  MM
  DD
  YYYY
- Grade Next September*
- Age*
- Gender*
- School*
- Has your Camper attended Valley Mill Camp before?*
- Health Information*
- Date of Last Tetanus Shot*
- Parent 1 Information
- Parent 1 Name*
  First Last
- Parent 1 Cell Phone*
- Parent 1 Work Phone*
- Parent 1 Email*
- Parent 2 Information
- Parent 2 Name*
  First Last
- Parent 2 Cell Phone*
- Parent 2 Work Phone*
- Parent 2 Email*
- Emergency Contact Information
- Emergency Contact Name*
  First Last
- Emergency Contact Phone*
- Privacy Policies
- 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, please do not 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, please do not share my information with other parents
- Registration Policies
- I understand Holiday Camp requires a minimum of 15 campers in order to run the program. If that minimum is not met, I will receive an email in advance of that date.*
  - By checking here you agree that you read and understood the statement above.
- YOUR APPLICATION WILL NOT BE CONSIDERED UNTIL THIS FORM IS SIGNED (BELOW), SUBMITTED (BELOW) AND PAYMENT 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.
- Electronic Signature Agreement -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.*
  - By checking here you agree that you read and understood the statement above.
- 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 Above Signer*
  First Last

Registration Form

Camper Information

Parent 1 Information

Parent 2 Information

Emergency Contact Information

Privacy Policies

Registration Policies