Camper Applicaton
Camper Information Sheet
This information must be signed by a parent/guardian or attendee if over 18.
All persons attending Valley View Camp, Inc., whether visiting for the day or residing overnight; must have completed this form. This form should be submitted to Valley View Camp, Inc. upon arrival of the rental group. Parents and/or Rental Group are responsible for providing transportation to and from Valley View Camp, Inc.
All campers are expected to follow the directions of all staff
Camper Name ___________________________________________ M/F____ Date of Birth ___________
Street Address ________________________________________ City/St/Zip _______________________
Parent/Guardian _____________________Home Phone __________ Work Phone __________
Cell Phone __________ Insurance Co __________________________ Policy/Group No ______________
E-Mail________________________________________
Do you have any allergies or medical conditions or other info we need to know? _________________________________________________
Date of last tetanus shot/booster ________. Is camper taking any regular medication? Yes____ No ____
Medication List ___________________________________________
If Swimming:
Do you know how to swim? Yes ___ No ___ Does the camper have permission to swim? Yes ___ No ___
CONSENT FOR MEDICAL OR SURGICAL TREATMENT
In the event that I or my dependants listed below should become ill or be injured while at camp I, as parent or guardian, authorize __________________(group name) Staff and/or the staff of Valley View Camp, Inc. to secure and give consent for any medical or surgical evaluation and or treatment by the physician or hospital of their choice. I understand that all reasonable efforts will be made to contact me in the case of an emergency.
Parent/Guardian Signature ___________________________________________
WAIVER OF LEGAL LIABILITY
I, _____________________ (parent/guardian), for myself, my children or dependants listed above, acknowledge that my signature below constitutes a full waiver of all legal liability against Valley View Camp, Inc., its employees, agents, associates, hiking, creek wading, archery arts and crafts, and team sports. I give permission for photography or videotaping of any camp activities. I have instructed my child about the importance of following the directions and instructions of the Valley View Staff. Should I be requested to do so I will abide by all decisions of the camp directors and management up to and including removing my child from camp.
__________________________________________ Date __________________________
(signature of parent/guardian or attendee)
2.2.11
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Office Use Only Date/Time Received ____________________ Received By _______________
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