Sign Up Boys Week: July 11-16 Girls Week: July 18-23 If you are registering two campers, please register them here. Our boys camp is currently full. Please email us at comollenhourcamp@gmail.com to be added to our waiting list. 2021 Camp Registration Donation Amount: $ 225.00 Camper’s Name Date of Birth Age During Camp Camp Week Registering for: Girls Week Return Camper Return Camper Yes No Years Attended Camp Shirt Size Shirt Size Youth S Youth M Youth L Adult S Adult M Adult L Adult XL Street Address City State Zip Code Parents/Guardians Names Cell Phone Work Phone Emergency Contact Relationship Cell Phone Work Phone By choosing yes to this release form as marked below, I authorize C.O, Mollenhour Conservation Camp, to use the following personal information of my child: (1) My child’s picture – including photographic, motion picture, and electronic (video) images. (2) My child’s voice – including sound and video recordings. I hereby grant C.O. Mollenhour, its subsidiaries, licensees, successors, and assigns, the right to use, publish, and reproduce, for all other purposes, my child’s name, pictures of my child in film or electronic (video) form, sound and video recordings of my child’s voice, and printed and electronic copy of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media, including, without limitation, cable and broadcast television and the internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences, and in brochures and other print media. This permission extends to all languages, media, formats, and markets known or herby devised. This permission shall continue forever unless I revoke the permission in writing. I further grant C.O. Mollenhour all right, title, and interest that I or my child may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant C.O. Mollenhour the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer-generated scanned image and other electronic media that may be used in conjunction there with or to approve the eventual use that it might be applied. I acknowledge that I have read the foregoing and I fully understand the contents. Photo permissions Photo permissions Yes Will your camper be taking medication during camp week? Will your camper be taking medication during camp week? Yes No Please list any medications your camper will be taking during camp week. Please list any other medical information here. Select Payment Method Credit Card Personal Info First Name * Last Name Email Address * Credit Card Info This is a secure SSL encrypted payment. Donation Total: $225.00 {amount} donation plus {fee_amount} to help cover fees. 2021 Camp dates Boys Week: July 11-16 Girls Week: July 18-23 When to arrive We would love to see your camper at 2:30pm sharp on Sunday. Pick-up and our award ceremony is at 6:00pm on Friday. Curious what to bring? What to bring and what not to bring can be found on our camper information page. Camp Rules and Expectations lEARN MORE HERE
