2010 Summer Youth Camp Registration
Please Choose a Camp:
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June 13-19 Young Teen 1 (7th-9th)
June 20-26 Senior High (9th-'10 grad)
June 27-July 3 Junior 1 (3rd-6th)
July 11-17 Young Teen 2 (7th-9th)
August 1-7 Junior 2 (3rd-6th)
August 1-7 Adventure Camp (7-10th)
August 2-6 Day Camp (k-3rd)
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Extra activities are available during youth camps. Horsemanship is offered as an instruction hour where your camper can spend 1 hour a day with the horses. Paintball focus is for YT or SH camps, where students can play paintball one hour each day, with extra games throughout the week. Ranch camp is an opportunity for JR campers to experience a week full of horses. They will spend 3 hours a day in horse related activities.
Please choose any extra activities:
Horsemanship Instruction Hour ($60)
Paintball Focus ($65) (YT & SH)
Ranch Camp ($65) (JR 2 Camp)
Camp T-shirt ($8) (specify t-shirt size below)
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Camper Name
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Address
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City
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State
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Zip Code
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Phone Number
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Grade in fall
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male
female
Camper Date of Birth
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E-Mail
Church
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T-Shirt Size (only needed if ordering a shirt at this time)
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
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I have never been to camp before, and the friend listed here invited me to camp.
They receive a reimbursement at the end of the summer (cool for them) and I get a free T-shirt (cool for me). (Don't forget to mark the size of your t-shirt above.)
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List two people you would like in your cabin:
Special Dietary Needs
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Medical Information
Camper date of birth
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Camper social security # (not required)
Health Problems/Special Needs
Polio Vaccine Current:
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Date of last Tetanus Vaccination
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Regular Medication
Allergies
Activity Restrictions
Please notify VCBC if your child has had a communicable disease.
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In the Event of an Emergency
Parent/Guardian Name
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Parent/Guardian Phone
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Parent/Guardian Cell Phone
Address if different than camper
Other Emergency Contact
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Emergency Phone #
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2nd Emergency Contact
2nd Emergency Phone #
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Physician's Name
Physician Phone #
Health Insurance Co. & Phone
Policy #
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Parents! Please read, sign, and date the following:
CAMP ACTIVITIES: Understanding that all camp activities have some risk involved with them, I give my son/daughter permission to participate in all camp activities. If there is an activity your child cannot participate in please list it in activity restrictions in health information. For all activities available please visit our website at www.villagecreek.net. I understand that this form does not guarantee the availability of the activity during the camp week. The camper will sign up for these activities upon arrival to camp. PHOTOS AND TAPING We regularly photograph and videotape campers and their families at camp. Photos and images may be printed in our brochures or our videos for promotional materials. If you wish to not be photographed or videotaped, please contact us in writing with your request. The photos and video highlights filmed through the week are used to make a DVD movie, given to each camper at the end of the week. HEALTH INSURANCE Our insurance provides secondary coverage while your camper is at VCBC and engaged in camp-sponsored activities. Our camper insurance begins where yours terminates. Please provide us with the name of your health insurance carrier and your policy number.
IN CASE OF MEDICAL EMERGENCY, I hereby give permission to the physician selected by the camp director to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child, as named above.
By clicking "I agree" below, you are signing your name electronically.
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I agree
NO
My name is:
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Today's Date is:
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Payment
We have two options of discounts:
Multiple week discount: Attend more than one week of youth camp and receive $50 off the second week. (Excludes day camp and family camp)
Sibling Discount: If more than one camper from a family attends, regardless of the youth camp, each of them will receive a discount of $25.
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You may pay just the deposit now ($75) or pay the entire camp cost. If you are using the multiple week discount or the sibling discount, please just pay the deposit online now, as our payment modular does not allow for discounts. Your discounted balance will be available for you to pay at registration on the Sunday of the Camp week, or you may call Jodi in the office anytime to pay the balance.
Please choose one
*
I want to pay the full camp fee now.
I want to pay just the $75 deposit now (balance due on Sunday of camp week)
Registration Fee 2010 Youth Camp
*
Deposit Only Summer Youth camp
$
75.00
USD
Youth Camp (JR, YT, SH)
$
315.00
USD
Adventure Camp
$
390.00
USD
Day Camp
$
175.00
USD
Horsemanship Instruction Hour
$
60.00
USD
Paintball Focus (YT &SH)
$
65.00
USD
Ranch Camp (JR 2 Camp)
$
65.00
USD
Camp T-Shirt ($8 in advance or $15 at campstore)
$
8.00
USD
Total:
$
0.00
USD
Submit and Go to Payment Page
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