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Family Day Registration
Register today!
Simply fill out the form below to register for Family Day!
Price
(Required)
Family Day
Family Member Name
(Required)
First
Last
Gender
(Required)
Male
Female
Family Member Date of Birth
(Required)
MM slash DD slash YYYY
Email Address
(Required)
Receive updates via email?
(Required)
Yes
No
Second Family Member Name
First
Last
Gender
Male
Female
Second Family Member Date of Birth
MM slash DD slash YYYY
Family Address
(Required)
Street Address
Address Line 2
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Armed Forces Americas
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State
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Church You Attend
City/State
Family Member first time coming to Deep Valley
Yes
No
Second Family Member first time coming to Deep Valley?
Yes
No
Medical Information
Family Member Allergies
(Required)
Eggs
Milk
Gluten
Peanuts
Shellfish
Soy
Tree Nuts
Other
None
Select All
If other, what?
If you selected an allergy above, please elaborate so that we may best serve in case of an emergency
Second Family Member Allergies
Eggs
Milk
Gluten
Peanuts
Shellfish
Soy
Tree Nuts
Other
None
Select All
If other, what?
Add Kids
Yes
No
Kids Information
Kids Name
First
Last
Kids Gender
Male
Female
Kids Date of Birth
MM slash DD slash YYYY
Second Kids Name
First
Last
Second Kids Gender
Male
Female
Second Kids Date of Birth
MM slash DD slash YYYY
Third Kids Name
First
Last
Third Kids Gender
Male
Female
Third Kids Date of Birth
MM slash DD slash YYYY
Fourth Kids Name
First
Last
Fourth Kids Gender
Male
Female
Fourth Kids Date of Birth
MM slash DD slash YYYY
Kids Medical Information
First Kid Allergies
(Required)
Eggs
Milk
Gluten
Peanuts
Shellfish
Soy
Tree Nuts
Other
None
Select All
If other, what?
If you selected an allergy above, please elaborate so that we may best serve the camper in an emergency.
Second Kid Allergies
Eggs
Milk
Gluten
Peanuts
Shellfish
Soy
Tree Nuts
Other
None
Select All
If other, what?
If you selected an allergy above, please elaborate so that we may best serve the camper in an emergency.
Third Kid Allergies
Eggs
Milk
Gluten
Peanuts
Shellfish
Soy
Tree Nuts
Other
None
Select All
If other, what?
If you selected an allergy above, please elaborate so that we may best serve the camper in an emergency.
Fourth Kid Allergies
Eggs
Milk
Gluten
Peanuts
Shellfish
Soy
Tree Nuts
Other
None
Select All
If other, what?
If you selected an allergy above, please elaborate so that we may best serve the camper in an emergency.
Emergency Contact
Emergency Contact
(Required)
First
Last
Emergency Contact Phone Number
(Required)
Relationship
(Required)
Recreational Activity Release of Liability
(Required)
Express Waiver of Risk(s) Associated with Recreational Activities:
I, as parent or legal guardian of my child, hereby affirm and acknowledge that I fully understand the hazards and risks associated with the many outdoor and other recreational activities which my child may engage or participate in at Deep Valley Christian Service Camp. The inherent risks and hazards include but are not limited to:
1. Injuries sustained from any and all outdoor activities, such as running, jumping, hiking, swimming, biking, climbing, cooking, engaging in sporting events such as basketball, volleyball and more.
2. Injuries sustained from objects that are either natural or man-made, such as rocks, cliffs, trees and campfires, or from misjudging trails or other terrain that induces slipping, falling, colliding or otherwise.
3. Injuries and illnesses from swimming, diving, impacting the water and/or water entering bodily orifices.
4. Injuries from hypothermia, heat stroke, dehydration, etc. from exposure to the elements, such as rain, cold, excessive heat or the weather in general.
5. Injuries or illnesses sustained from either plants or animals, such as poison ivy, poison oak, poison sumac, aggressive or biting pets, service animals, wildlife, or exposure to any plants or animals present within the camp in general.
6. Accidents, injuries or illnesses occurring in remote locations where no immediate medical attention is available.
I UNDERSTAND THAT THE DESCRIPTION OF THESE RISKS IS IN NO WAY COMPLETE AND THAT ALL SUCH DANGERS, BOTH ANTICIPATED AND UNANTICIPATED, CAN LEAD TO ILLNESS, INJURY, PERMANENT DISABILITY, DROWNING OR DEATH.
I acknowledge that I have read and agree to the Waiver of Liability and Medical Consent statements
Electronic Release
I permit my child or myself to be included in the camp group picture, general pictures, and/or video recordings to be featured on electronic or printed media for camp promotional purposes.
I agree
Any additional Information
Payment
Church Sponsored Discount
Name of Church Paying Tuition
Credit Card
Total
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