EmpowHER Outdoors
Squeaky Boots LLC
Parent/Guardian (Primary person of contact)
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First Name
Last Name
Parent/Guardian Email
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example@example.com
Primary Phone Number
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Secondary person of contact:
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First Name
Last Name
Secondary phone number:
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Child/Club Member
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First Name
Last Name
Preferred pronouns (For example: she/her, he/him, they/them, she/them, he/them, etc...)
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Grade Level
*
6th Grade
7th Grade
8th Grade
Please list any medical and/or dietary needs and/or allergies your camper has. Type N/A if none.
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PHOTO/VIDEO/STATEMENT RELEASE FORM: I grant permission to Squeaky Boots LLC and its employees the irrevocable and unrestricted right to produce photographs and video taken of my child while at Squeaky Boots LLC's Hiking Camp for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium. I hereby release Squeaky Boots LLC and its legal representatives from the liability for any violation or claims relating to said images or videos. Furthermore, I grant permission to use the statements of my child given during an interview with or without the name for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right or my child’s right to any and all compensation stemming from the use of these materials.
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Yes
No
PHOTO/VIDEO/STATEMENT RELEASE SIGNATURE (if marked "no" please leave this section blank)
I have read and agree with Squeaky Boots LLC's Liability Waiver and Child Abuse Protocols.
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Where did you hear about EmpowHER Outdoors?
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Word of Mouth
Facebook
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Flyer Posted
My child's school
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Other
Interested in a payment plan?
Send us an email at squeakybootsllc@gmail.com to enquire about our payment options.
Club Fees and Backpacking Gear Add-ons
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EmpowHER Outdoors 2023 Club Fees
Weekly club meetings (guided hikes, snacks, hat, LNT ethics card, sticker, and activities/workshops) and weekend backpacking experience (4 meals, snacks, and backcountry permit)
$
500.00
Backpacking Backpack Rental
One size
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Tent
Sharing with other club member.
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Sleeping Mat
One size
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Sleeping Bag
One size
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Hiking Poles
Adjustable
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Cooking Kit
Includes: fuel, stove, lighter, pot, spork, and an animal/water proof food-bag hanging system.
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Toilet Kit
Includes wipes/toilet paper, disposable bags, and trowel.
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Head Lamp
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Registering with a payment plan.
You have already enquired and received a reply concerning our payment plan information.
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
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