Parent Name *

First Name

Last Name

Which of the following activities would your child have difficulty with? Check all that apply. *

We have determined these to be the basic expectations for a camper to safely participate in an outdoor, overnight, multi-day, remotely located camping program.

Walking for short and long periods of time on rugged terrain

Climbing

Attending to personal needs

Following group instructions

Understanding and complying with rules

Remaining vigilant about hydration and sun safety needs

Does your child have any of the following medical conditions: *

Diabetes

Heart Condition

Uncontrolled Asthma or Other Lung Condition

Other (Fully describe in the box below.)