Video Game Camp Permission and Release
The Rockwood DIY Video Camp will teach youth basic coding and gaming skills. We may hold field trips within walking distance of Rockwood DIY (location 484 SE 187th and Stark St, Portland, OR) to give kids a break outdoors. In case of a medical emergency, we will bring your child to Adventist Urgent Care at 18750 SE Stark St, Portland, OR 97233. In order for your child or ward to participate in the Rockwood DIY Video Game Camp (includes walking field trips) we require you to complete this form. If yourself, your child or ward check out any equipment, you are responsible for its replacement if it is lost, stolen or broken. By filling out this form you consent to the terms above.
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Email *
Participant's First Name(s) *
please list all participants' first names, separated by commas
Participant's Last Name(s) *
please list all participants' last names, separated by commas
Parent or Guardian First Name *
Parent or Guardian Last Name
Parent or Guardian Email
Parent or Guardian Phone
Parent or Guardian Address
Dietary Restrictions *
put "none" if no restrictions
Allergies/Medical Info We Should Know *
put "none" if no allergies/medical info we should know
Emergency Contact Person (besides you or parent) *
Emergency Contact Phone  (besides you or parent) *
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