Summer Camp Waitlist Registration
Thank you so much for your interest in Rogue Valley Mentoring's free Rising Resilient Summer Camp, for youth ages 9 to 14 years old!  We are currently full and not accepting any more applications, however, we do have a waitlist and if a slot opens we will reach out. The waitlist is also first come first served!

Please, complete this form for each youth you would like to register.  Reach out to 541-708-6688 or Nechelle@rvmentoring.org with questions or technical issues.
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Youth First Name *
Youth Last Name *
Youth Preferred Name
Youth Gender *
Youth Pronouns
Clear selection
Youth Date of Birth *
MM
/
DD
/
YYYY
Street Address *
Apt/Suite
City *
State *
Zip *
Youth Phone Number
Type
Clear selection
May we text this number with info and updates while youth is enrolled?
Clear selection
Youth Race: please, check all that apply. *
Required
Youth Languages Spoken *
Shirt Size: youth's size in standard, adult, unisex t-shirts. *
Youth Grade *
Youth School *
If you answered 'Other' for Youth School, please specify here:
Youth Food or Environmental Allergies: please, list any known allergens, and the expected allergic reaction to them. *Write 'None' if youth has no known allergies. *
List any daily medications for youth: write 'None' if youth takes no medications. *
Is Youth diabetic? *
My child may have up to 200-400 mg of Advil every 4-6 hours, for headache or muscle-aches (1-2 tablets). *
Is there anything else you would like RVM to know about your youth?
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