Enrollment
Application

Please complete each section as indicated. No camper will be registered until all information requested is received.

 

   Application

CONTACT:

  

Information for the person responsible for this application (Mother or Father of camper):
     
Name*  
email*  
     
   Participant's Information

PERSONAL INFORMATION:
     
Name(s)*  
Last Name*  
Nickname:  
Years at Valle Verde   (Years camper has attended VV).
     
Birthday*  
Age at Camp  
Email  
School  
     

Gender*

  

Male Fem

 

 

ADDRESS:
     
Home Street Address  
ZipCode / Other address info  
City / Province / State / Country  
Home Phone  
     

Camper lives at home with::

  

Both Mother Father Other

 

 

MOTHER'S INFORMATION:
     
Name*  
Occupation  
Cell / Phone / Pager*  
Email  
     

 

 

FATHER'S INFORMATION:
     
Name*  
Occupation  
Cell / Phone / Pager*  
Email  
     
   Health Information

The following information is gathered to assist us in identifying appropriate care.

ALLERGIES:

  

(Foods, Drugs, Other) Please elaborate in detail:

     
   
     

 

SPECIAL CONDITIONS / CONCERNS:
     
    Special Medical Conditions
(Asthma, Diabetes, Epilepsy, Migraine Headaches,Infections, Recent Operations or Illnesses)
Please elaborate in detail:
   
     
    Other Health Problems or Concerns
(Sleeping, Diet, Conduct, ODD, Illnesses, Other)
Please elaborate in detail:
   
     

 

MEDICATIONS:

  

Please list ALL medications being sent to camp, and read our Medications Policies.

     
   
     

You MUST include (for each Medication):
(A) Medication Name, (B) Dosage, (C) Administration Times and, (D) Reason for Taking.

 

ADDITIONAL INFORMATION:
   

   * Are there any other medical problems about which Camp Valle Verde should be made aware?

Yes No

   * Does your camper take any other medications that will not be sent to camp?

Yes No
     

Additional Notes

About Health

  
     

 

 

 

EMERGENCY CONTACT (in case we cannot contact parents):
     
Name / Relationship  
Cell / Phone / Pager  
     
  Registration Information

CAMP SESSION:

  

Select your Camp. Dates and Fees

     
   


 

SPECIAL PROGRAMS IN VALLE DE BRAVO
     
 

-2010 Spring BASE
-2010 Spring PRO
-2010 Summer 1 MEGA (Week 1)
-2010 Summer 1 MEGA (Week 2)
-2010 Summer 2 MEGA (Week 1)
-2010 Summer 2 MEGA (Week 2)
-2010 Summer 3 BASE
-2010 Summer 4 BASE
 

-2010 Summer 1 MEGA
-2010 Summer 2 MEGA
-2010 Summer 3 BASE
     

Extra Fees Apply.

 

OTHER PAYMENTS:

  

 
     
 

( $300 MXN per week is recommended)
 

(Pre-Sale Price)

 

 

 

PAYMENT PREFERENCES:

  

The application deposit is a requirement. Balances are due one month prior the first camp session attending.
     
 
     
 
     

Once we receive all information requested in the application, we will contact you and send via e-mail a Payment Request to be paid through PayPal.

   Additional Information

CABIN MATES:

  

First year campers are given preference for cabin mates.
Please list a maximum of two persons, who are the camper's age (within 12 months of each other).
     
    (1)
    (2)
     

 

 

 

VALLE VERDE SURVEY:
     
    How did you first learn about Camp Valle Verde?
    Please elaborate:
     
    The Camp Session that I have chosen for my family is based primarily on:
    Please elaborate:
     

 

 

 

SUGGESTIONS / COMMENTS:

  

for our Services and Information:
     
   
     

 

 

 

RECOMMENDATION:

  

Please give us the information of two relatives or friends that could be interested in Valle Verde:
     
Name  
E.mail (or phone)  
     
Name  
E.mail (or phone)  
     
   Confirmation

The application will not be valid unless all information requested is received

This application can only be submitted by the camper's Parent or Guardian.

     
   

To the best of my knowledge, this camper does not have a communicable disease, and is physically able to participate in all Camp activities except as indicated above.

All medical problems or conditions requiring ongoing medical supervision or care have been fully noted.

I give permission for this health information to be shared with the appropriate Camp staff and outside Medical Personnel as necessary.

I understand that I will be notified if extended care is provided by the Camp Health Center, or following assessment or treatment by a local physician.

In case of emergency, if I cannot be reached, permission is hereby given to the Camp staff to take whatever steps deemed necessary to ensure the safety and health of my camper.

I agree to notify the Camp in writing if any changes occur in my camper's health status, medications, or family status between now and the start of the Camp session.

     
   

MY NAME BELOW INDICATES THAT ALL INFORMATION ON THIS APPLICATION FORM IS COMPLETE AND ACCURATE.

     
    Full Name* (Parent or Guardian):
   
     
    *I, THE PARENT OR LEGAL GUARDIAN OF THE ABOVE NAMED CHILD, HAVE READ CAMP VALLE VERDE'S POLICIES AND PARTICIPATION CONTRACT AND AGREE TO ALL TERMS.
     
 
     

 

If you have any problem while sending the application, you can use the "BACK" button of your browser, to recover the information.