Summer Intensive Registration Form

New Treks Summer Adventure Weeks 2022 Registration Form

Please carefully fill out the form
Youth's Name (Nombre del Participante) *

Last Name (Ultimo Nombre) First Name (Primer Nombre)
Birth Date (Fecha de Nacimiento) *

Month Day Year
Entering Grade *
Gender (Género) *
Address (Dirección) *

Street Address (dirección de casa)

Street Address Line 2

City (Ciudad) State / Province (Estado/Provincia)

Postal / Zip Code (Código Postal)
Please list any medical conditions, allergies, dietary restrictions, etc. that we should be aware of (Enumere las Afecciones Médicas que Debemos Conocer y el Tratamiento)
Parent/Guardian Name (Nombre del Padre/Guardián) *

Last Name (Ultimo Nombre) First Name (Primer Nombre)
Phone Number (Número de Teléfono) *
Please enter a valid phone number. (Por Favor Ingrese un Número de Teléfono Válido)
Email *
example@example.com
Emergency Contact (Contacto de Emergencia Adicional) *

Last Name (Ultimo Nombre) First Name (Primer Nombre)
Emergency Contact Phone Number (Número de Teléfono) *
Please enter a valid phone number. (Por Favor Ingrese un Número de Teléfono Válido)
List Any Additional Authorized Contacts or Pickup Persons
*Optional* Additional Demographic Information (select all that apply) (*Opcional* Información Demográfica Adicional)

Native Indian or Alaska Native/Nativo India o Nativo de Alaska Asian/Asiático Black or African American/Negro o Afroamericano Native Hawaiian or Pacific Islander/Nativo Hawaiano o Isleño del Pacifico Latino/Hispana White/Blanco Other/Otro
*Optional* Does your Youth Qualify for Free or Reduced Lunch? (*Opcional* ¿Su Joven Califica para Almuerzo Gratis o Reducido?)

Yes/Si No
Please provide documentation of Free and Reduced Lunch to qualify for the reduced price. (Por Favor Proporcionar Documentación para el Almuerzo Gratis o Reducido.)

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How did you hear about New Treks? *
*Optional* Primary Language Spoken at Home (*Opcional* Idioma Principal Hablado en Casa)
Additional Comments (Commentos Addicionales)
Adventure Week Selection (Selecion de Semana Aventura)

Please select the activity you wish to register for. After registration is complete an email will be sent asking for the deposit to hold your reservation, accompanied by the waivers that need to be signed. If the intensive is full we will notify you and put you on a waiting list. All waivers will be sent to your email for signature. Full payment will be required by May 16, 2022. ***If you selected that your youth receives Free and Reduced Lunch you will be sent the adjusted payment rate.***
Intensive Options *
prev next ( X )
Backpacking Intensive June 13-17, 2022 Grades 8-12 *Discounted price of $389 for Free/Reduced Lunch reflected after selection
$ 489.00 Entering Grade Level Do you Qualify for Free/Reduced Lunch?

Rock Climbing Intensive July 25-29, 2022 Grades 8-12 *Discounted price of $389 for Free/Reduced Lunch reflected after selection
$ 489.00 Entering Grade Level Do you qualify for Free/Reduced Lunch?

Paddling Intensive July 11-15, 2022 Grades 8-12 *Discounted price of $389 for Free/Reduced Lunch reflected after selection
$ 489.00 Entering Grade Level Do you qualify for Free/Reduced Lunch?

Primitive Skills Mini Intensive June 29 - July 1, 2022 Grades 8-12 *Discounted price of $199 for Free/Reduced Lunch reflected after selection
$ 299.00 Entering Grade Level Do you qualify for Free/Reduced Lunch?
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New Treks Summer Adventure Weeks 2022 Registration Form

Adventure Week Selection (Selecion de Semana Aventura)