Camp Registration Form

Camper Information and Registration: Season 2008

___ Session I    July 5 thru July 9, 2010 (Full) 	$995.00

	
            *Payment is due in full.
		     
______Check Enclosed            ______Please charge my 
                                      Visa or Mastercard

Camper Name  __________________________  AGE ________________________
Address _____________________________________________________________
City  __________________ State _____ Zip Code _______________________
Parents Names _______________________________________________________
Phone (___)__________CellPhone (___)__________email__________________
Medical Insurance ___________________________________________________
Group Number _________ Policy Number ________________________________
Emergency Contact: __________________________________________________
Is Camper allergic to Bee Stings? 			   No     Yes
Does Camper have any Food Allergies?                       No     Yes
If yes, please list here: ___________________________________________
Does camper know how to swim?				   No     Yes
Please note:  All campers are required to wear pfd's (life jackets) 
while boating and under the direction of camp hosts.

Liability Release
O'Brien's Rogue River Outfitters, LLC is authorized to use its own 
judgment for the immediate handling of any situation and act as 
guardian for the above named child.  if necessary, in the judgment of 
O'Brien's Rogue River Outfitters to use hospitalization, medical, or 
dental aid for the health and well being of the camper, I hereby 
authorize O'Brien's Rogue River Outfitters and its members to use 
such outside aid.  Payment for such medical care will be paid by my 
family insurance.  I understand that no refunds will be made in the 
event that my child must be removed from Camp for disciplinary 
reasons (illegal drugs, alcohol, or extreme behavior deemed unfit 
for the other guests of O'Brien Rogue River Outfitters).  I will 
allow photos of my child to be used for promotional purposes.

Billing Information:
Name:  ______________________________________________________________
Address:_____________________________________________________________
City:____________________________State:____Zip:______________________
Phone:  ________________________Email:_______________________________

Visa/Mastercard Number:______________________________
Expiration Date: __________	
Three or Four digit code on back of card: _________
I authorize O'Brien's Rogue River Outfitters to Charge my credit card 
for the above payments on the above dates. 
Signature: __________________________________ Date: _________________

*Please understand that when a reservation is made with O'Brien's Rogue
River Outfitters and Raft Camp it is a commitment for us to reserve 
space for you and possibly turn other business away from that particular
trip date. If you decide to cancel, it can be difficult for us to rebook
a trip, especially trip cancellations close to the trip date. With this 
in mind, we must be firm in following our cancellation and refund 
policy. Thank you for your consideration.

Full payment is due with registration. Cancellation fee of $200.00 will
be charged more than 60 days prior to Raft Camp Session, balance of 
$695.00 will be refunded. Cancellations made 60 days or 
less prior to Raft Camp start will forfeit the entire payment.

We encourage you to purchase camp insurance at My CampProtector.com 
in case of an emergency or need to cancel.

You can reserve your trip over the phone with MasterCard or Visa.
We will hold a reservations date for you for 10 days, if you prefer 
to send a personal check or money order.