Registration Form

B. V>.Safe and Active Family Experiences June 30^th to August 15^th, 2008

For more information: email BVSAFE@gmail.com

Sponsored by: Bear Valley Parents Group POB 5186 Bear Valley CA 95223

Camper Name: ______________________M/F Grade in fall ___Birthday ___Age____

Camper Name: ____________________M/F Grade in fall ___Birthday ___Age____

Camper Name: ______________________M/F Grade in fall ___Birthday ___Age____

Camper ethnicity: (for grant purposes only)____________________________________

Parents Name:__________________________________________________________

Local address_________________________________Phone:____________________

Permanent address______________________________________________________

Perm address phone ________________________cell__________________________

Email__________________________________or______________________________

Any special needs or info we need to know about camper? (i.e. meds, health, disabilities, medical diagnosis)______________________________________________

Please identify any person(s) other than parent or guardian who is authorized to pick up your child from camp:_____________________________________________________

All Parents/Guardians and Campers must provide an original signature below.

I the camper/parent/guardian understand that Camp will include, but is not limited to activities such as swimming, rock climbing, boating, and hiking. I realize that children can become injured at camp. I hereby assume all risk of injuries to my child and hereby release and discharge Bear Valley Parent Group, Inc., Bear Valley Residents Inc., B.V. Adventure Co., B.V. Lodge, B.V. Tennis Club, and Aurora Bound Inc., dba Mountain Adventure Seminars from any and all liability which may result in injury to my child. I further agree that insurance protection is my responsibility. In case of emergency I understand every effort will be made to contact me. In the event I cannot be reached I hereby give my permission to the physician selected by the Camp administration to hospitalize and secure professional treatment (including surgery) for my child. I assume financial responsibility for all actions of my child which may cause damage to property or the personal possessions of others. If the staff deems it necessary for my child to be removed from camp, due to disciplinary or other problems, I will respond by promptly picking up my child.

I agree to all terms and conditions that are stated in this camper application and registration form.

Parent or Guardian signature: _______________________________Date:___________

Camper signature:________________________________________Date:___________

Medical Ins. Co. Name ____________________________Policy#__________________

Calstar#_______________________________________________________________

Office use only: Amt recvd: _____________Check # ________Date recvd:___________

Notes:_________________________________________________________________

Registration Form Page 2

All Campers MUST be 6 years old to participate and cannot by older than 18.

Camp runs Monday thru Friday from 9:30 a.m. to 2:30 p.m. (Camp check-in begins at 9:15, spots will be held until 9:30 for permanent Campers before they are offered to walk in day campers.)

(1^st Child) (Additional Siblings)

Full Camp: (7 weeks = $11.43/day $400. $250./each

Camp by Week: $100. $75/each

Camp by Day: $ 25. $20/each

Full payment is due with registration form.

Weekly or Daily Campers, please pre-register your dates below to reserve your spot.

Full Campers should provide any dates to us they know they will not be attending.

All pre-registration takes precedence over walk-ins but spots cannot be guaranteed.

There are only 24 daily spots available.

Dates you would like to attend:_____________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Full Campers: Dates you will not be in attendance:(Please note there are no refunds for days not able to attend)__________________________________________________________________

We are looking forward to the best B.V.S.A.F.E Bear Valley has ever seen!

See you soon!