SafeGround Youth Camping Registration & Consent
Complete the youth details, emergency contacts, and permissions, then wait for SafeGround’s confirmation before traveling.
Parent/Guardian Information
Parent/Guardian Full Name
*
First Name
Middle Name
Last Name
Parent/Guardian Full Name
First Name
Middle Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Stepparent
Grandparent
Legal Guardian
Foster Parent
Other
Primary Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
City / ZIP Code
*
Preferred Contact Method
*
Phone
Text Message
Email
Youth Information
*All information is required for each child*
Youth Legal Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
Gender for Sleeping Arrangements
Female
Male
Prefer not to say
First-Time Camper?
*
Yes
No
Youth Legal Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Gender for Sleeping Arrangements
Female
Male
Prefer not to say
First-Time Camper?
Yes
No
Youth Legal Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Gender for Sleeping Arrangements
Female
Male
Prefer not to say
First-Time Camper?
Yes
No
Youth Legal Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Gender for Sleeping Arrangements
Female
Male
Prefer not to say
First-Time Camper?
Yes
No
Youth Legal Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Gender for Sleeping Arrangements
Female
Male
Prefer not to say
First-Time Camper?
Yes
No
Preferred Name (You may add each preferred name in this field)
Emergency Contact
Emergency Contact Name Other Than Parent Listed Above
*
First Name
Last Name
Relationship to Youth
*
Please Select
Parent
Grandparent
Sibling
Aunt/Uncle
Family Friend
Neighbor
Other
Primary Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized to Pick Up Child?
*
Yes
No
Medical & Support Information
Allergies
*
None
Food
Environmental
Medication
Insect Stings
Other
Asthma or breathing concerns
*
No
Yes
Not Sure
Needs an EpiPen or similar emergency allergy medication
*
No
Yes
History of seizures
*
No
Yes
Diabetes or blood sugar concerns
*
No
Yes
Dietary restrictions or food needs
Physical limitations or mobility needs
Current medications and when they are taken
Anything staff should know
Camping Comfort
Comfort level with camping
*
Very comfortable
Somewhat comfortable
Neutral
Somewhat uncomfortable
Very uncomfortable
Fears or concerns about camping
What helps calm or comfort the child
Equipment
Does the child have a tent?
*
Yes
No
Tent size
Please Select
One-person
Two-person
Three-person
Four-person
Family-size
Other
Does the child have a sleeping bag?
*
Yes
No
Does the child have a flashlight?
*
Yes
No
Does the child have a camping chair?
*
Yes
No
Sleeping Arrangements
Sleeping arrangement preference
*
Share with sibling
Share with requested participant
Camper can be assigned based on gender
Requested participant
First Name
Last Name
Additional sleeping arrangement notes
Authorized Pickup
Authorized Adults
*
Identification will be required at pickup.
Pickup Authorization Acknowledgment
*
I understand that adults picking up the youth will be asked to show identification
I confirm that only the adults listed here are authorized to pick up the youth
Activity Participation
Approved activities for my child to participate in
*
Nature walks
Campfire programs
Group games
Arts and crafts
Activity restrictions or special instructions
Emergency Medical Authorization
Authorize emergency care if needed
*
Yes
No
Attempt to contact parent/guardian before treatment when possible
*
Yes
No
Medical information certification and comments
Parent Acknowledgments
I acknowledge the overnight nature of this camping event and understand my child will be away from home
*
Yes
I acknowledge that outdoor activities involve inherent risks such as weather changes, uneven terrain, insects, and other environmental hazards
*
Yes
I will not sue SafeGround Board Members or volunteers for incidents beyond their control
Yes
I confirm that the medical and support information provided is complete and accurate to the best of my knowledge
*
Yes
I understand my child is expected to follow camp rules, adult instructions, and behavior expectations at all times
*
Yes
I understand that pickup may be required if my child cannot safely remain at the event or does not follow rules set for participation
*
Yes
I agree to the event's pickup requirements and will ensure an authorized adult is available if needed
*
Yes
I agree not to share the private location of the camping site with unauthorized persons
*
Yes
I agree to report any changes to my child's health, emergency contacts, or other important information before the event
*
Yes
Signatures
Parent Printed Name
*
First Name
Last Name
Parent Electronic Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Youth Name
*
First Name
Last Name
Youth Name
*
First Name
Last Name
Youth Acknowledgment Signature
*
Submit Registration
Submit Registration
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