Youth Camping Registration & Consent
Enter parent/guardian details, youth information, emergency contacts, and medical notes, then confirm consent for participation and emergency care.
Parent/Guardian Information
First Name
*
Middle Name
Last Name
*
Relationship to Child
*
Please Select
Please Select
Parent
Guardian
Grandparent
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
Youth Legal First Name
*
Youth Legal Last Name
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
Gender
*
Please Select
Female
Male
Prefer not to say
Additional Child
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Please Select
Female
Male
Prefer not to say
Additional Child
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Please Select
Female
Male
Prefer not to say
Additional Child
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Please Select
Female
Male
Prefer not to say
First-Time Camper?
*
Yes
No
Preferred Name(s)
Emergency Contact
First Name
*
Last Name
*
Relationship to Youth
*
Please Select
Please Select
Grandparent
Aunt/Uncle
Sibling
Family Friend
Neighbor
Coach
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
Asthma or breathing concerns
*
Yes
No
Not Sure
Needs an EpiPen or similar emergency allergy medication
*
Yes
No
History of seizures
*
Yes
No
Diabetes or blood sugar concerns
*
Yes
No
Dietary restrictions or food needs (Specify which child if multiple children listed)
Physical limitations or mobility needs (Specify which child if multiple children listed)
Current medications and when they are taken (Specify which child if multiple children listed)
Anything staff should know (Specify which child if multiple children listed)
Camping Comfort
Comfort level with camping
*
Very comfortable
Somewhat comfortable
Neutral
Somewhat uncomfortable
Very uncomfortable
Fears or concerns about camping (Specify which child if multiple children listed)
What helps calm or comfort the child (Specify which child if multiple children listed)
Equipment
Does the youth have a tent?
*
Yes
No
Does the youth have a sleeping bag?
*
Yes
No
Does the youth have a flashlight?
*
Yes
No
Does the youth 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
Requested participant last name
Additional sleeping arrangement notes
Authorized Pickup
Authorized Adults for Pickup
*
Activity Participation
Approved activities
*
Nature walks
Campfire programs
Group games
Arts and crafts
All Activities
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
Parent Signature
*
Youth Signature
*
Submit
Gender
Please Select
Female
Male
Prefer not to say
Gender
Please Select
Female
Male
Prefer not to say
Should be Empty: