Registration Form

 

Student Name:  Camp #:               
Age:                      Shoe size:  T- Shirt size: 
Home Phone Number:  
Address:  
City:   Zip:  
 Email:@  
Parent Name[s]:  
Cell Phone Number:  
Emergency Contact: Medical Insurance:Yes  No
Medical Insurance Carrier:  
Policy Number: Group Number:
   
Medical conditions:  

 Click to Download and Print Waiver Form                                         

Please print this form out and sign below before clicking submit.  A $50 non-refundable deposit check, payable to Central Oregon Youth Adventures, LLC, needs to mailed to 64835 Hunnell Road, Bend, OR
97701 to reserve your spot.  Include this form with your payment. You will receive an email confirmation with additional details. Thanks, Greg & Beau

Parent Signature_____________________________________

Student Signature______________________________________

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