Wilderness Skills Camp Registration Form

Wilderness Skill Camp Registrations

Please register, must be done in order for your child(ren) to attend camp, ages 9-15 maximum of 20 students and minimum to run camp will be 10.
What Will Be Covered

Mr. Scharmer will cover the survival attitude, equipment/tools, shelter, water/hydration, fire/insulation, foraging edible plants and hunting/trap/fish, cooking/food prep, tracking, camouflage, knots and traps, and navigation/orientation.

Who is Lucas Scharmer

Lucas Scharmer is an outdoor enthusiast with a passion for wilderness survival. He spent several summers as a wilderness canoe guide and outdoor trip leader. Lucas has attended numerous survival courses and taught the topic to students for several seasons. He holds a master's degree in education for curriculum and instruction in science and taught high school science for several years before moving to Montana. He now works in the medical equipment field and spends his spare time with his wife and 4 children.

Our Session will costs $300.00, $35.00 Charge for a shirt.

Session 1: July 15th-18th

Monday-Thursday 9-3pm

Location: To be sent once fully registered and fully paid. The location is between Church Hill and River Rock) We will be using residence land, and their property backs up against state land, so we can utilize all of this land.

Time: 9am-12:00 (lunch) (Outdoor Education) After lunch -until- parent Pick-up (Wilderness Survival Skills with Lucas Scharmer

Packing List

Day Pack

Rain Gear

Sun hat

Sunscreen

Boots/Hiking shoes that can get wet

Water Bottle

**Pocket Knife (Please note we will be using this for learning about proper knife skills and safety. If you do not feel comfortable letting your child have a knife, then please do not send them with one)

Lunch

Snacks

Warm layer (hat, light gloves, extra sleeves)

Journal/Pen or pencil
Camper's Information
Member ID
Camper Name*
Gender

FemaleMale
Date of Birth*

MonthDayYear
Age by June 17th*
NOTE - Offering 1 sessions for preteen and teen 9-15 years of age only.
Entering Grade in 2024/25*
Camp Registering For?*
T-Shirt Size
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program?

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell Phone*
Home Phone
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Parent's Work/School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would you like to be reached while your child is at camp?*

Cell PhoneWork PhoneHome Phone
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Parent/Guardian 2
Parent/Guardian 2*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell Phone*
Home Phone
Home Address Same as Parent/Guardian 1?

Yes
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Parent's Work/School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork PhoneHome Phone

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Heading

Emergency Contact #1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number
Relationship to Child*
Heading

Emergency Contact #2
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number
Relationship to Child*

Medical / Health Information
Name of Physician or Clinic/Hospital
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Does your child have any food, medication or environmental allergies?*

YesNo
Allergies? Check all that apply*

FoodMedicationEnvironmental
Please list and explain any allergies*

0/150
Does your child have a special health or medical condition?*

YesNo
Please explain*

0/150
Does your child have any dietary restrictions*

YesNo
Please explain*

0/150

Payment and Statement of Understanding
Ignite Learning Center a program of Greater Impact Inc has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*
Type first and last name above to consent
This form, after being completed and signed by the parent/guardian, must be reviewed for completeness and signed by the administrator/designee prior to the child receiving care. After the child is attending the program the administrator shall have the parent/guardian review and initial the form when any changes/updates are made and at least annually. The parent/ guardian and the administrator or designee shall initial and date the form in the section below to indicate when the form was last reviewed.*
Type first and last name above to consent
Please click here to pay your deposit, for each child you are registering.
Sign Document*
Date Signed*

MonthDayYear
Camp Director Name and Contact Info
Should be Empty: