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Parent Name(Required)

Camper / Player Information

T Shirt Size

Emergency Contact

We like to take pictures!
If you do not want your child photographed for our website and future promotional materials, please check the box.
Medical Release
This is to certify that the above-named child has had a physical examination by a licensed physician within the last six (6) months and is free from any illnesses, injuries, or conditions which could inhibit the child from activities of the camp. I will notify coaches prior to the camp or clinic of any physical conditions that may inhibit play. I hereby release the Pacific Island Community of Oregon, its staff and sponsors from any and all liability (present and/or future) for injuries that may be incurred by my child while participating in camp activities.
(Please type name to serve as signature of parent or guardian)


After registration, you will be taken to a payment page. The cost of the camp is $52.29, including the Paypal processing fee. After payment you should receive a confirmation email from Paypal, that will serve as your registration number, and if you do not receive it, please contact us at