2026 Required Participant Form

REQUIRED PARTICIPANT FORM

To be filled out by a parent/guardian
Participant Information
Camper's Name (Please enter it the exact way as on the initial registration form)*

First NameLast Name
Birth Date:*

MonthDayYear
Date
Age upon arrival at camp:*
Camper's Height*
Camper's Weight*
Coming with a friend? What's their name?
Camper's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Parent/Guardian to be contacted:*

First NameLast Name
Primary Parent/Guardian relationship to camper*
Primary Guardian's Contact Phone*
Primary Alternate Phone:*
Enter 000 if no other number.
Primary Guardian's Contact Email:*
example@example.com
Primary Guardian address same as Campers?

Yes
Primary Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Emergency Contact (in event primary contact cannot be reached)*

First NameLast Name
Secondary emergency contact relationship to camper*
Secondary Contact Phone:*
Please enter a valid phone number.
Secondary Contact Email:*
example@example.com
MEDICAL INSURANCE
Insurance Company:*
Policy Holder Name:*
Policy Number:*
Insurance Phone #*
Please enter a valid phone number.
Primary Care Physician*

First NameLast Name
Primary Care Physician Phone#*
Please enter a valid phone number.
HEALTH HISTORY
How would you rate this camper's ability to swim?*
Allergies*

No known allergiesFoodMedicineEnvironmentalOther
ALLERGIES*
Please describe in detail the allergen and level of severity. It is very important that our leaders know to what extent a camper can tolerate an allergy i.e. requires immediate medical attention/epi pen or can tolerate with mild discomfort. If the allergy requires an Epi-Pen, I, the undersigned, understand that I must send the participant with his/her personal Epi-Pen.
Diet*

No dietary needs or restrictionsVegetarianVeganGluten FreeLactose FreeOther
DIETARY RESTRICTIONS*
Please let us know if these dietary restrictions are by choice or due to an allergy. If vegan or vegetarian, please let us know if your camper will tolerate eggs, tuna, or cheese while on the trail.
MEDICATIONS
Will your Camper be taking any medications?*
Please let us know if you have any further information you think we ought to know about your camper.

The following Over the Counter medications are stocked in our first-aid kits and infirmary. Please check off any items that may NOT be used to treat your camper.

Acetaminophen (Tylenol)Ibuprofen (Advil, Motrin)Antihistamine/allergy medicine (Benadryl)Antacid tabletsCalamine lotionHydrocortisone CreamAntibiotic creamPovidone for wound cleaning
Anything else we need to know?
Use this space to tell us about any other conditions or reasons for medications the would be pertinent for your camper's leaders to know.
Parent/Guardian Authorization for Health Care/Medical Treatment at Emergency Room or Urgent Care:
This health history is correct and accurately reflects the health status of the camper to whom it pertains. The person described has permission to participate in all camp activities except as noted by me and/or an examining physician. I give permission to the physician selected by the camp to order x-rays, routine tests, and treatment related to the health of my camper for both routine health care and in emergency situations. If I cannot be reached, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the information on this form will be shared on a “need to know” basis with camp staff. I give permission to photocopy this form. In addition, the camp has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child's health status.
Signature of Parent/Legal Guardian*

Clear
Date*

MonthDayYear
Date
Camper Health Physical

Please upload a copy of your camper's most recent health physical, including any other pertinent medical documents. The health physical should be completed by a physician within the past two years. You may choose to take a picture of or scan the forms.
CAMPER HEALTH PHYSICAL - completed by a physician within the past 2 years*

Please upload your camper's Health Physical here.
Cancelof
Participant Agreement

We ask that parents and participants read the following and indicate acceptance by signing in the spaces provided below. WAEL is designed to be fun and exciting; it is neither a therapeutic program nor “boot camp” for troubled kids. Participants must arrive willing and eager to participate and cooperate. They should be fully informed of the nature of the program and included in the decision to attend our program. For the benefit of the individual and the group as a whole—as well as to help ensure safe, wholesome, and responsible behavior at all times—Wilderness Adventure has set forth the following Participation Agreement. Failure to comply with these guidelines may result in dismissal from the program and return home, without eligibility for a refund.
I, understand that the outdoor activities of WAEL are exciting, character building, and fun; however, I understand that at times, the activities may be strenuous and physically challenging. I will cooperate with the other group members and the staff, do my best to maintain a positive attitude, a strong work ethic, respect for myself, those around me, and the environment in addition to working on positive communication skills.
I further understand that the following are prohibited:
- Profanity, vulgarity, obscenity, and discriminatory comments or jokes.
- Religious, ethnic, cultural, racial, and sexual slurs or jokes.
- The use of alcohol, tobacco, vape pens, or illegal drugs.
- Stealing: unauthorized removal or use of another’s property.
- Misuse or willful destruction of company or personal property.
- Harassment of any kind: any persistent behavior deemed to be annoying, troubling, or offensive.
I understand that I am responsible for my own conduct at all times and agree to follow the rules and expectations set forth by my leaders and the WAEL staff. The goal of my trip is to have fun, learn new skills, make friends, and leave having had a positive experience. I agree to abide by the above and I am enthusiastic about participating in the program.

I understand that any violation of the above may be grounds for expulsion and immediate return home—at my own expense—without refund.

I have read, understand, and agree to this Participation Agreement.
Participant's Name*

First NameLast Name
Participant's Signature*

Clear
REFUND/CANCELLATION POLICY ACKNOWLEDGMENT

General Refund/Cancellation Policy
Our cancellation policy is based on our investment in food and equipment purchases, program planning, and staff training. Due to our small group size, many sessions fill by April 1st. Cancellation on short notice often prevents others from attending, and we may be unable to recover our expenses. Because of the financial consequences of canceling within 30 days of a session, we strongly recommend you purchase refundable airline tickets and travel insurance, which will reimburse you for cancellation under certain circumstances (e.g., medical reasons, family illness, etc). For more Information on travel insurance please look at the section below. Tuition will be refunded for cancellations according to the following schedule:

Prior to April 1.............................………………....................... Full refund, less a $75 processing fee.

Between April 1 and 30 days prior to the session …...........…. Refund of all tuition, less 25% deposit.

Within 30 days....................................................................... No refund.

Cancelation Due To Injury Or Illness:

Within 30 days of start date: If a cancellation within 30 days of the session is due to a non-pre existing illness or injury (documented by the attending physician), we will apply all amounts with-held to future tuition (less a $75 processing fee and any amounts already committed to an outfitter for a contracted activity).

Injury or Illness during camp session: If a participant is sent home due to a non-pre existing illness or injury, we will apply a prorated amount to future tuition (less $75 and any amounts already committed to an outfitter for a contracted activity). However, once the camper turns 18 years old, any credit not used will be forfeited.

Behavior Issues during camp session: No refund will be given if a participant is sent home for behavioral issues or otherwise violating our Participation Agreement, or if a participant voluntarily withdraws for whatever reason. We reserve the right to cancel sessions or change schedules due to unforeseen circumstances. Certain trips require a minimum number of participants. In the rare event that we must cancel a session prior to the starting date, we will refund all amounts paid.

Homesickness/Self-Removal
Due to the structure of our program we cannot issue refunds when a participant goes home early due to homesickness or by choice. We encourage all parents to address potential homesickness and challenges with their child prior to the start of their trip, discuss that these feelings are normal and will pass, and ensure that their child is indeed ready for our program.

Medical Treatment
Wilderness Adventure at Eagle Landing shall have the right to give first aid to any participant. We shall also have the right to retain the services of a physician, or if necessary, to hospitalize a participant. All expenses related to physician care, medication, or hospitalization (including travel expense if the participant has to be sent home) shall be paid by the parent/guardian or reimbursed to us (such amounts will be added to the participant’s camp store bill). All participants must be covered by medical insurance. If you do not have medical insurance, we request that you purchase an inexpensive policy specifically for the length of stay with us.
Signature of Parent/Legal Guardian*

Clear
Date*

MonthDayYear
Date
Release & Assumption of Risk

I have read over the website and am aware of the activities comprising Wilderness Adventure at Eagle Landing’s all-outdoor program including, but not limited to, camping, backpacking, canoeing, kayaking, caving, mountain biking, low ropes course, climbing wall/rappelling tower, rock climbing/rappelling, high ropes course, and zip line. I understand the risks and hazards involved in such activities, including, but not limited to, vehicle travel, hiking on irregular and steep terrain, the forces of nature, rough water conditions, animals in the wild, and accidents or illness in remote places. Therefore, in consideration of my child’s acceptance into the Wilderness Adventure at Eagle Landing Summer Camp Program, I, the undersigned, assume all the above risks and understand that activities may be subject to injury. I understand that such injuries may include broken bones, paralysis, or other serious injury or death. I, personally and on my child’s behalf, agree to forever waive, discharge, and release all claims that I or they may have against Wilderness Adventure at Eagle Landing, inc. and its officers, directors, shareholders, and employees, arising out of or resulting from my child’s participation in the Summer Youth Program. The undersigned represents that they are the sole and legal guardian(s) of the above named child.

Governing Law/Venue

I agree that all matters arising out of or resulting from the participant’s attendance at Wilderness Adventure at Eagle Landing shall be governed by Virginia law, and that all claims or proceedings shall be brought in the Circuit or General District Courts of Craig County, Virginia.
Participant's Full Name:*

First NameLast Name
I CERTIFY THAT I AM THE PARENT OR LEGAL GUARDIAN OF THE MINOR NAMED ABOVE. I HAVE READ AND UNDERSTAND THE RISKS INVOLVED IN THIS ACTIVITY. IN CONSIDERATION OF THE MINOR BEING PERMITTED TO PARTICIPATE, I AGREE TO BE BOUND BY THE TERMS OF THIS WAIVER AND RELEASE.

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Parent/Legal Guardian Name (Print):*

First NameLast Name
Signature of Parent/Legal Guardian*

Clear
Date*

MonthDayYear
Date
11176 Peaceful Valley Rd, New Castle, VA 24127 540-864-6792
Should be Empty:

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REQUIRED PARTICIPANT FORM

Participant Information

MEDICAL INSURANCE

HEALTH HISTORY

MEDICATIONS

Parent/Guardian Authorization for Health Care/Medical Treatment at Emergency Room or Urgent Care:

Camper Health Physical

Participant Agreement