Camper Registration
Adult Registration
PA Application
Changes Form
Online Payment
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

Camper Registration Form
(Must be completed for all Camper, PAs, and Tagalongs) 

 * =  Fields that are required!

 

As a note on these online forms, Do not use the enter/return key within boxes for details, just type and let the information wrap itself.  Hitting enter or return will cause your information to be lost and the form to fail.

 

CAMPER
First Name   * Last Name   *
Street Address  *    
City   * State   *
Zip Code   * Gender Female  Male  *
Home Phone Number   * Birth Date   *
School Next Fall   * Grade Next Fall   *
Tee-Shirt Size   * Troop Number   Enter 0 if none *
I am a child of a Full Time Volunteer? Yes  No    
       
Buddies are an option at camp, but not required.  Each camper can have only one buddy and both
campers must request one another, sign up for same units, and be in same grade level.
Buddy First Name    
Buddy Last Name    

Try-It and Badge choices:  Please rank your campers choice for Unit work at Camp.  Remember that even if your camper ranks a badge as their first choice, they may be placed with the Unit for their second choice because of limitations on group sizes and availability of each Unit as camp fills up.

First Choice Try-it/Badge Second Choice Try-it/Badge Third Choice Try-it/Badge
     

PARENT/GUARDIAN # 1   
 (Note: most of the following information is not required, but can be used to contact you in an emergency)

First Name   * Last Name   *
Home Phone Number   * Work Phone Number ext
Cell Phone Number I can help at the Bus Stop Yes  No
Email Address Email is a good way to contact me for pre-camp issues Yes  No

PARENT/GUARDIAN # 2   
 (Note: most of the following information is not required, but can be used to contact you in an emergency)

First Name   Last Name  
Home Phone Number   Work Phone Number ext
Cell Phone Number I can help at the Bus Stop Yes  No
Email Address Email is a good way to contact me for pre-camp issues Yes  No

Emergency Contacts
If unable to reach parent or guardian, please contact:

First Name   * Last Name   *
Phone Number   * Alternate Phone
Relation to Camper    

or

First Name Last Name
Phone Number Alternate Phone
Relation to Camper    

FEES
Choose which fee for this camper registration.  Optional demographics may also be entered.  Please remember that all online registers must be registered Girl Scouts (Pixies and Widgets excluded!) if you have not already filled out a Membership application and paid the $10.00 membership fee to the registrar, you can Not use online registration.  Please follow the instructions for paper registration on the Registration page.

Camp (select one) * Registered Girl Scout Camper - $100.00
Program Aide-In-Training (PAIT) - $100.00
Program Aide (PA) - $30.00
Pixies and Widgets (ages 3-5) - $30.00
Boys (grades 1-6) - $30.00
Bus Fee Deduction  I am a registered Camper (not PA or sibling) of a full time (5 day) Adult Volunteer and may deduct the $10.00 bus fee from the $90.00 campers fee.
Thursday Overnight Camper Yes, my camper is staying for the Thursday overnight, I will include the $10.00 fee in addition to the registration fees from above.
No, my camper is not staying overnight, so I do not need to include the additional  $10.00 fee, and will pay the fees as listed above only.
Racial Background
(Optional) Used for statistical purposes only, voluntarily given.		 I do not want to provide this information
American Indian or Alaskan Native
Asian
Black or African American
Hawaiian or Pacific Islander
White
Other
Ethnic Background
(Optional) Used for statistical purposes only, voluntarily given.		 I do not want to provide this information
Hispanic or Latina
Not Hispanic or Latina
Bus Stop
All campers and PAs must ride the bus (except staff children)		 Mountain View School (Farmington Road, Aloha)
Target on Beaverton-Hillsdale Hwy
Home Depot on Murray near Hwy 26.
No bus, I am with a full time (5-day) Adult Volunteer
Photo Policy
Camp Policy is to allow photographs to be taken for personal use only, for example, group photos that will be sent home with the camper.  Please check below if you wish No photographs of your camper at all.
Only check if you Do not want any pictures taken of your camper at all.

Health History Form
(Must be completed for all Camper, PAs, and Tagalongs)

Physician Name   * Physician Phone   *

CONDITIONS
Check those that apply.  Explain any checked items in the box below.

Allergies:
Insect Bites/Stings Medications/Drugs  
Hay Fever or Pollen Food Other
Chronic or Recurring:
Seizures Asthma  
Diabetes Other
Other:
Medications given at camp 
Medications normally given at home 
Other
Check here only if there any restrictions concerning physical activities?  (please explain below)
Explanation of items checked above or additional information:  Please provide any additional information that would be needed for health and/or safety concerns, or that would be beneficial in helping the staff to prepare for the best camp experience possible.  Do not use the enter/return key within the box below, just type and let the information wrap itself.  Hitting enter or return will cause your information to be lost and the form to fail.
Are there any behavioral issues of which the staff should be aware?  Please let us know if your child might need some special attentions at camp.  This information will be treated with the utmost of respect to your camper's privacy, and will not be used to exclude your child from camp, but rather to help match your child with appropriately prepared staff to ensure everyone has the best camp experience.  Camp is not a recommended time for going off of normal medications.  Do not use the enter/return key within the box below, just type and let the information wrap itself.  Hitting enter or return will cause your information to be lost and the form to fail.
Immunizations:
What was the most recent year of Tetanus shot or DTP immunization?                                            


Over the counter medications:  According to the Day Camp Protocols and Health Care Procedures, our health care staff can administer certain types of over the counter (OTC) medications.  In order for your camper to be able to receive these, we need to have a parent/guardian signature.  By checking any of the boxes below you are electronically signing consent for that medication to be administered by our staff at Camp to your camper if she/he requires/requests it for a viable reason.

Camper May Receive OTC Medication Type
 Acetaminophen (Tylenol)                                            
 Ibuprofen
 Benadryl (antihistamine)
 Sudafed (decongestant)
 Tums (antacid)
 Robitussin (expectorant)
 Sunscreen (without PABA, min. SPF 30)
 Insect repellant (may contain up to 15% DEET, unscented)
Calamine Lotion (remember, there IS poison ivy out there!)

Food Questionnaire Form

There are a variety of foods and snacks available at camp, therefore your camper may be exposed to a wide variety of potential allergens.  Please assist us in identifying dangerous allergens, strong dislikes, or any known food issues for your camper.

My camper has serious food allergies Yes    No
My camper knows of their allergies and will monitor their own eating Yes    No
My camper is a vegetarian Yes    No
My camper can eat food provided at camp, should she/he choose to do so Yes    No

Please explain any allergies or strong dislikes.  Although there is no guarantee that certain foods will not be present at camp, letting us know ahead of time can help the staff to anticipate and overcome any food issues with your camper.  Do not use the enter/return key within the box below, just type and let the information wrap itself.  Hitting enter or return will cause your information to be lost and the form to fail.
 

Electronic Signature Form
(Must be completed for all Camper, PAs, and Tagalongs)

I, as a parent/legal guardian of the camper named above, agree to conduct camp registration transactions electronically, as provided for by ORS Chapter 84, and to be bound by that law.  *

I AGREE:        Choose this option to continue registering online through this website.

I DISAGREE:  If you choose this option, you will be required to print, fill out, and submit paper forms.

Parent/Guardian Permission and Release
(Must be completed for all Camper, PAs, and Tagalongs)

I, as a parent/legal guardian of the camper named above,  give permission for her/him to participate in all phases of camp activities except those noted for exclusion in this form.  I understand and agree to cooperate with all camp and Girl Scout regulations.  I will not allow her/him to attend camp if she/he is not in good physical condition.  In an emergency, when the parent/guardians cannot be reached, I give permission for the camp authorities to take any emergency measure deemed appropriate.  The parent/guardians will be notified as soon as possible.

 

I certify that the health history provided above is complete and accurate.  My child has permission to engage in all prescribed activities, except as noted for exclusion in this form.  In case of illness or injury, I give permission for her/him to receive first aid, receive requested or required OTC medications and to receive emergency treatment from a licensed physician.  I understand that all reasonable efforts will be made to contact the parent/guardians.

 

I release Columbia River Girl Scout Council, Inc. from any and all liability and damages, including any claim for injuries incurred by my child as a result of participation in this Girl Scout activity.

 

By typing my name below and clicking the "I AGREE" button, I acknowledge that I fully understand and agree to all provisions of this Permission and Release and that this action is equivalent to signing a printed copy of the Permission and Release.

Name:  You must provide complete and accurate first and last name: *                                           

I AGREE:        Choose this option to continue registering online through this website.

I DISAGREE:  If you choose this option, you will be required to print, fill out, and submit paper forms.

 

 

 

2007 - 2008 Mountaindale East Day Camp / For technical help with this page, please email webmaster@mtndale-east.org