Patriot Camp 2023 Online Registration
Hello and welcome to Star Valley Patriot Camp 2023. Please enter the following information for the person you are registering. You will need to submit a separate form for each person you want to register. (If you prefer, you may download the registration form here and submit by mail with your payment). 

Sign in to Google to save your progress. Learn more
Email *
Camper, Patriot, or Volunteer Information
Are you registering for a Camper, a Patriot, or a Volunteer? 
Campers must be entering 1st grade through entering 6th grade. 
Patriots must be entering 7th grade through entering 8th grade.
Volunteers must be entering 9th grade through adult.
Camper, Patriot, or Volunteer?
 *
First Name
Last Name

 *
Mailing Address

 *
City 

 *
State

Zip Code

 *
Age of camper or patriot volunteer: *
Required
School attending this Fall: *
Required
Allergies & Health Issues:
Does the person you are registering have any allergies, health issues, or other issues that our staff needs to be aware of?  If so, please list them in the space below: If none- type "none"
 *
T-Shirts:
Your registration includes one T-shirt, what size would you like? To be safe, order a size up.  
 *
Additional T-Shirts:
If you would like to order additional T-shirts, they are $12 each and $14 for 2XL & 3XL. Please select your size below. 
 *
Parent/Guardian Information
Please enter information for the parents/guardians of Campers, Patriots, and Youth Volunteers. Adult Volunteers should enter their own name.
Parent/Guardian First and Last Name *
Parent/Guardian Preferred Phone Number (Please include area code)  *
Parent/Guardian e-Mail Address *
Emergency Contact Information
Please  give us the name of your emergency Contact
 *
Relationship to registrant *
Required
Phone Number of Emergency Contact *
Photo Release 
I hereby authorize the Star Valley Patriot Camp staff to use, reproduce, and/or publish all written and/or visual materials, including photographs and video that may pertain to me or my children. I understand that this material may be used in various publications, public affairs releases, recruitment materials, or for other related endeavors. This material may also appear on the Star Valley Patriot Camp Internet Web Pages and/or Facebook pages. This authorization is continuous and may only be withdrawn by my specific
rescission of this authorization. Consequently, the Star Valley Patriot Camp staff may publish materials, use my name, my child's first name, photographs, video, and/or refer to me or my child in any manner that the Star Valley Patriot Camp staff, deem appropriate in order to promote/publicize the event/program.
Consent for Photo Release
Liability Waiver - Youth
If you are the parent/guardian of the registrant, please read the following waiver of liability. Checking "I agree"
constitutes your legal waiver as written.I certify that I am the parent or legal guardian of the registrant, and the registrant has my permission to participate in Patriot Camp 2023. I certify that my child has adequate accident insurance, and I will not hold Star Valley Patriot Camp leaders/staff liable for any and all claims related to participation in this program.
Consent for Youth *
Required
Liability Waiver - Adult
If you are the adult volunteer registrant, please read the following waiver of liabilty. Checking "I agree" constistutes your legal waiver as written. I certify that I have adequate accident insurance and I will not hold Etna Community Center or Star Valley Patriot Camp leaders / staff liable for any and all claims related to participation in this program.
Consent for Adult
 *
Required

Volunteer Availability:

We will give registration priority to kids who have a family representative who can volunteer at camp. The family representative can be a parent, grandparent, teenage sibling, other relative babysitter, or family friend – there are many options! Adults are especially needed. Please check below whether you will have an adult or a teenage volunteer, or if you cannot provide a volunteer.

 Once you have registered your kids, please enter a separate registration(s) for the volunteer(s) associated with your family. When you register the volunteer(s), please choose the last option.

Can your Family Provide a Volunteer(s)?

 *

Number of Days Volunteer Can Help at Camp: If your family has BOTH an adult and a teen volunteer, please check the availability for the adult.

 *
Required

Volunteer Details: Use the space below to explain your volunteer situation and availability.

 *
Payment
By submitting this registration form, we are agreeing to pay the following fees, either by mail (address at end of this form) or by bringing to the first day of camp:
 *
Payment Mailing Address:
Payment can be mailed to:
SVPC
c/o Sally Bailly
PO Box 3317
Alpine, WY 83128

Please contact us regarding a Scholarship Request, or for any other questions you may have:
svpatriotcamp@gmail.com
Sally - 406-570-0486
Tracey - 907-854-6825
Jackie - 307-890-6801
Star Valley Patriot Camp Dates, Times, Location
Monday, June 19th - 9:30am-11:30am
Tuesday, June 20th - 9:30am-11:30am
Wednesday, June 21st - 9:30am-11:30am
Thursday, June 22nd - 9:30am-11:30am
 Friday, June 23rd - 9:30am-11:30am

Etna (Star Valley) Community Center
107736 US-89 Suite 109, Etna, WY 83118


Etna (Star Valley) Community Center
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms