Backpack Trip 2025 Application
July 4 - 6, 2025, Itasca State Park, MN
Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Parent Email
*
example@example.com
Phone Number
Mobile Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Medical Information
Does the child have allergies including asthma?
*
Please explain on the field provided
Is the child currently under medication?
*
Please provide the details, the name of the medication and period of intake
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Contact Information in Case of Emergency
Name
*
First Name
Last Name
Contact Number
*
-
Area Code
Phone Number
Relation to Child
*
Name
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Relation to Child
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Signature of applicant or guardian representative
*
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YFC Consent and Release of Liability
Signature
*
Date
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
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Back Pack Trip Fee
prev
next
( X )
Fee
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Credit Card
Submit
Should be Empty: