Sponsored by:
Family Health Associates
600 NW 11th St. Ste. E-15
Hermiston, OR 97838
541-567-6434
Logo by Paula DiMauro
Who:
Children who will be going into 1st – 5th grade this fall. This 4-Day camp is designed for
kids who work well in large groups as they will be required to go outside, into the animal
barns and participate in various activities on the fairgrounds. The camp will be staffed for the
size of the group so participants must be potty trained and be able to function independently
within group setting. Children will be released each day, ONLY to those listed on registration
form.
*Space is limited on first come/first serve basis*
When: Tuesday, August 8th – Friday, August 11th
8:30am - 4:30pm at the new Umatilla county fairgrounds located
at the Eastern Oregon Trade & event center (eotec)
New Address: 1705 E Airport Road, Hermiston, OR 97838
WHAT: This will be a fun filled week focusing on things to do on the fairgrounds. Campers
will have fun arts and crafts, science experiments and music. They will follow a daily schedule
and attend activities and events happening at the fair for the full Umatilla County Fair
experience. Campers will also be performing on stage on Friday (parents will receive
performance time.)
COST: $65.00 PER CAMPER FOR THE 4-Day Camp
Price includes a camp T-shirt to be worn each day of camp, plus a week long fair admission
pass, and a carnival bracelet ($30 value) that will be handed out at the end of the week. This
can be used by the camper anytime Friday after camp ends, or all day Saturday for fun with
their family. (This will not be a supervised camp activity.) See camp director for details.
Campers will need to bring: A sack lunch each day, sunscreen, water bottle, back
pack and be ready for a fun filled week at the Umatilla County Fair! (Camp will provide 1
daily snack.)
Registration forms and fees are due to the fair office
and will be accepted until full
For more info, call the Fair office at 541-567-6121
Email: [email protected]
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2017 Umatilla County Fair
Fun @ the Fair Day Camp Registration
August 8-11 (camp dates)
Family Health Associates
600 NW 11th St. Ste. E-15
Hermiston, OR 97838
Please fill out one form per child
PO Box 94
1705 E Airport Rd.
Hermiston, OR 97838
Child's Name:
541-567-6121
Office Use:
Circle one:
Male
Female
Date Rec'd:
Date Paid:
Circle the grade your child
will be entering in Fall 2017 : Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
Pmt Type:
Release signed?
Shirt Size - (Choose One)
xtra small 4-6
medium 8-10
Xtra Large 12-14
standard retail youth sizes
small 6-8
large 10-12
Other Size (may cost extra) _________
Extra shirts may be purchased for $10 each. I would like ______ extra camp shirts.
Orders for extra camp shirts must be received by July 1, 2017
Family Information:
Child lives with:
Relation to child:
Name
Cell Phone:
Daytime Phone:
Other legal guardian:
Relation to child:
Cell Phone:
Daytime Phone:
Child will be released only to the care of custodial parents/legal guardians or the person(s) listed
below. The following people may also be contacted and are authorized to remove the child from camp
in the case of illness, accident or emergency if for some reason the custodial parent/legal guardian
cannot be reached: (Picture ID must be shown)
Name:
Daytime Phone:
Name:
Daytime Phone:
Media Release: I hereby give my permission without restriction to the Umatilla County Fair and its assignees
to photograph or videotape my child during their participation in the Fun at the Fair Camp. I specifically
waive any rights to compensation with respect to my child's name, likeness, picture and/or voice. The
purpose of this release is to facilitate publicity for county programs.
______________________________________________
Parent Signature
Applications accepted until full
Please fill out one registration form per child
Language Spoken at Camp: English
Payment is due on receipt of application
Inquire with the Fair Office for the required Medical Release
_____________________________
Date
Payment: $65 per child for Aug 8-11, 2017
Please make checks payable to:
UCF- PO Box 94
Visa/MC/Disc accepted
Hermiston, OR 97838
Call the fair office for
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Memo: Day Camp
details @ 541-567-6121
2017 Fun at the Fair Day Camp Release Form
Camper(s) Name(s): _________________________________________________ (ok to put siblings on one Release
form.)
I __________________________________ release Umatilla County and its Commissioners, Fair Board, Sheriff
Department, directors, managers, employees, agents, insurers and all related entities of the Umatilla County from any
and/or all claims, liabilities, demands, suits or causes of action whether actual or potential, known or unknown, which
arise out of or in any way relate to the undersigned activities at the 2017 Fun at the Fair Camp.
This release contemplates and includes any claims and remedies available under any state, federal, or local law or
authority, including attorney’s fees and costs. It is expressly understood and agreed that this release is intended to cover
and does cover not only all known injuries, losses and damages, but any further injuries, losses and damages not now
known or anticipated, but which may later develop or be discovered, including all the effects and consequences. Those
signing this release hereby declare that they have read this release and that it is fully understood and voluntarily
accepted for the purpose of making a full, final and complete release of any and all claims arising, in whatever legal form
or theory they might assert, in any jurisdiction.
My child /children, will be attending the Fun at the Fair Day Camp August 8-11, 2017 at the Umatilla County Fairgrounds
NOW LOCATED AT 1705 E. AIRPORT RD. in HERMISTON, OR 97838, AT THE EASTERN OREGON TRADE & EVENT CENTER
(EOTEC).
Initials___________
Medical Information
I _________________________________ hereby give my permission for any representative of the Umatilla
County Fair to authorize any medical treatment deemed necessary for my daughter(s)/son(s):
____________________, _________________________ (add names if needed).
(Umatilla County Fair staff will NOT administer medications. Inhalers or epipen may be administered in an
emergency situation only.)
Please list any allergies, medications and/or medical conditions (ie. bees, asthma etc...):
__________________________________________________________________________________________________
__________________________________________________________________________________________
Please note if an epipen or inhaler will be sent with the child: ___ epipen ___ asthma inhaler
Physician:
_______________________________
Name
____________________________
Phone Number
Parent/Legal Guardian Signature:
____________________________________
Parent Signature
_________________
Date
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