Camp Tadpole Registration Form
This is for session I (June 2nd, 2026, from 10 AM to 12 PM), for students 5-6 years of age. Please fill out all the required fields. Contact the office for any questions, (712) 623-4753. 20 student MAXIMUM.
Name of parent/ guardian completing this form
*
First Name
Last Name
Participant Name
*
First Name
Last Name
Name of additional participant
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
*
Format: (000) 000-0000.
Emergency Contact
Please fill out the following fields for an emergency contact.
Name of contact
*
First Name
Last Name
Relationship to camper
*
Phone Number
*
-
Area Code
Phone Number
Additional Comments
Camp Liability and Photo Release Agreement
All campers must have this completed before their camp date.
PERMISSION STATEMENT: I release the Montgomery County Conservation Board, Montgomery County, or the Montgomery County Board of Supervisors, or their respective administrators, directors, naturalist, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners, and lessors of premises on which the Activity takes place, (each considered on the “Releases” herein) from all liability, claims, demands, losses, injuries, damage to property, or other damage on my account caused or alleged to be caused in whole or in part by the negligence of the “Releases” or otherwise, including negligent rescue operations; and I further agree that if, despite this release and waiver of liability, assumption of risk and indemnity agreement I, or anyone on my behalf, makes a claim against any of the Releases, I will indemnify, save and hold harmless each of the releases from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim. I have read the agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.
*
Yes, I acknowledge and give permission for the camper(s) listed above to participate in camps held by MCCB staff.
No, I do not give permission for my camper(s) to participate.
ACCIDENT WAIVER AND RELEASE OF LIABILITY: Should any illness or accident occur on the trip, I will not hold our staff, volunteers, or the Montgomery County Conservation liable and I authorize staff to obtain the services of a medical doctor if necessary.
*
I give my consent on behalf of my camper(s) and acknowledge the conditions of this statement.
No, I do not wish my camper(s) participate in camp.
PHOTO RELEASE AND CONSENT: I acknowledge and confirm that the individual's photo can be used in Montgomery County Conservation's print, electronic, and social media. I grant permission to Montgomery County Conservation to use the photo of my camper(s) in its publications, including the Montgomery County Conservation newsletter. I release both the conservation board and photographer from any claims that may arise from the use of photos. I understand and agree that all photos will become the property of the Montgomery County Conservation Board. I have read and understand the terms set forth in this photo release and consent form.
*
Yes, you may use my camper(s)' photos in publications.
No, please do not use my camper(s)' photos in publications.
Please sign below acknowledging the terms and agreements listed above.
*
My Products
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Camp Tadpole Session I
Camp fee includes all supplies
$
30.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
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