2018 Day Camp Registration - Woodburn Week - Cash/Check Payment

June 18-22, 2018 | Please complete one form for each camper. Payment must be received at Mid Valley Community Church in order to process registration. Registration is first come first served.
 
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Emergency Contact Camp Week

 
 
 
 
 
 
 
Camper Info

 
 
 
 
 
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Buddy Request - For the most part kids are divided into groups by gender and grade level. You may request one buddy. No guarantees.
 
Canyonview General Release & Hold Harmless Agreement

I acknowledge that participation in the activities listed below involves inherent risk to the Participant (and to Participant guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage. In consideration for the opportunity to participate in the activities listed below (the “Activities”), the Participant (or parent/guardian) accepts the risk of injury associated with participation in and transportation to and from the Activities. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activities or during transportation to and from the activities, as well as for any medical treatment rendered to the Participant that is authorized by Canyonview Camp or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the Participant (or
parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activities Sponsor for any injury arising directly or indirectly out of the listed Activities or transportation to and from the Activities.

Canyonview Camp activities include, but are not limited to: archery, outdoor cooking, swimming, waterfront activities, creek walking, games, zip line (5th-6th grade), and pony rides.

I give my permission for my child to take the over-the-counter medications listed below as needed while attending Canyonview Camp: acetaminophen, ibuprofen, antihistamine, throat lozenges, anti-nausea, anti-diarrhea, antibiotic ointment, anti-itch cream, ipecac, aloe, eyewash, and sunscreen.

In case of a medical emergency for my child, I understand that every effort will be made to contact me. However, if i cannot be reached, I hereby authorize Canyonview staff to act in their best judgment to seek medical attention through appropriate means, including
ambulance transport and emergency room treatment as deemed appropriate by attending health care personnel. I also accept responsibility for expenses incurred through such treatments.

I authorize use of photos, videos, name, comments, etc. for promotional purposes. (If you do not want your participant's image, name comments, etc. used by Canyonview Ministries for promotional purposes, please submit a written request including a photo
purposes.)

I, therefore, sign my signature
 
Payment

Cash/Check Payment can be mailed to or dropped off at Mid Valley Community Church (591 Gatch St, Woodburn, OR 97071). Registration will be complete when payment is received. Registration is first come first served.
Please select one option.
Please select one option.

Description

June 18-22, 2018
Please complete one form for each camper. Payment must be received at Mid Valley Community Church in order to process registration. Registration is first come first served.