J•HIGH SUMMER CAMP REGISTRATION
DATES: July 20-22, 2018
LOCATION: Gergen Ranch - Oildale, CA
Questions? Contact elaina@realityventura.com
Email address *
CAMPER
First Name *
Last Name *
Gender *
Address *
City *
Zip Code *
Phone Number *
Email
Date of Birth *
MM
/
DD
/
YYYY
Grade *
School *
Allergies and/or Dietary Restrictions
Meds/Instructions *
Friend(s) you want to cabin with? (We cannot guarantee that we will be able to accommodate requests)
(1) Parent/Guardian Information
Information for primary parent/guardian in case of emergency (required)
First Name *
Last Name *
Phone Number *
Email *
(2) Parent/Guardian Information
Information for second parent/guardian (not required)
First Name
Last Name
Email
Phone Number
PHOTO/VIDEO CONSENT
I give my consent for photographs to be taken of my son/daughter during events sponsored in whole or in part by Reality Ventura to be reproduced and/or used in printed materials and websites which are the property of Reality Ventura, or other partners. I am aware that these photos will not be sold or used for profit other than for their presence in promotional materials, and I am aware that I will receive no compensation for the use of these photos.
I agree to the above photo/consent release. *
Required
RELEASE OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT
There are 2 liability releases that you will need to print, sign, and turn in. You can also attach the signed forms below.
• Reality Ventura
• Gergen Ski Ranch
Optional: Attach Signed Forms (see above)
PARTIAL SCHOLARSHIPS
Those wishing to apply for a partial scholarship -
Please contact Kevin@realityventura.com for information.
I have/will apply for a partial scholarship? *
PAYMENT METHODS
CURRENTLY YOU MUST PAY IN PERSON:
• Credit/Debit via Square - See Kevin
• Cash or Check - Give to Elaina or Kevin
I understand that my child's spot is not reserved until registration in paid in full. *
Required
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