Clone of 2025 Young Men Camp Registration-Leaders

Health Information and Consent

A health officer is on site at all times.
Medications, Dosage and Related Conditions

Please list all prescription and over-the-counter medications the individual is taking. If there are any changes to this list prior to camp, such changes must be communicated to the Stake Young Men Leaders before arrival at camp. All medications must be unexpired and in the original container, and if applicable, with the original pharmacy medication label including the individual's name.
List all medications, both prescribed and over the counter; bring all medication in original containers.
Does the individual have any allergies?
List any allergies (ex: medications, bees, peanuts, dairy)
Please list any chronic or recurring illnesses
Are there any limits, restrictions, or disabilities, that could prevent the individual from fully participating at young men camp?
Any dietary needs the camp should be aware of?
Are there any other needs or considerations the individual has that we should be aware of?
I understand that by signing electronically I authorize the leaders supervising this event to administer emergency treatment for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this event and travel to and from this event. I assume and shall be responsible for all medical costs and expenses in connection with the treatment contemplated by this waiver.
Leader's Name
Leader's Signature

Media Release
Occassionally, the Fallon Nevada Stake youth leaders would like to post and share photographs, videos, or audio recordings of the youth to our stake social media sites and/or our stake youth website. We need your permission to do so. These posts will be generated and approved by the stake youth leaders.
I, undersigned, agree with the selected statement:
Signature
Should be Empty:

2026 Young Men LEADER Camp Registration