Big Sur Land Trust Youth Outdoor Programs Participant Registration: Day/Multi-night Camps and Trainings LinkedInThis field is for validation purposes and should be left unchanged.This form is used for all Youth Outdoor Programs Day-Camps, Overnight Camps, and Youth Leadership Trainings.CAMP INFORMATIONDate(s) of participation:(Required)Location:(Required)LocationMarks RanchMartin DunesArroyo Seco RanchGlen Deven RanchMitteldorf PreserveAll Big Sur Land Trust Properties (for Youth Leadership Program only)PARTICIPANT/CHILD INFORMATIONName:(Required) First Last Address:(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email Address:(Required) Phone Number:(Required)Birthdate:(Required) MM slash DD slash YYYY Grade in school (as of August of the current calendar year):(Required)School attending, if applicable:(Required)How would you describe your or your child's experience swimming?(Required) Lots of expierence Some expierence Does not know how to swim HEALTH HISTORYDo any of the following apply to the participant? If yes, please check the box:(Required) Heart defects/disease Diabetes Asthma Experienced seizures Frequent headaches Fainting or dizziness Recent injury or surgery Frequent ear infections Recent infectious disease Physical disabilities Dislocations Recent life changes or trauma Emotional/behavioral difficulties Attention deficit difficulties None If yes to any of the above, please describe here:(Required)Please list any medications the participant carries with them and the correct use/dosage (i.e. antibiotics, asthma inhalers, epinephrine pens, etc.). If none, please type "N/A":(Required)Any medications brought to any Big Sur Land Trust Camp are required to be in original containers with current doctor prescription label attached. For OVERNIGHT camps, medications will be held and distributed by the Senior Camp Staff Person or responsible person named by the visiting organization.Please describe any allergies (food, medication, bee stings, animals, etc.). If none, please type "N/A":(Required)Please describe any participant dietary restrictions (vegetarian, vegan, etc.). If none, please type "N/A":(Required)EMERGENCY CONTACT INFORMATIONEmergency Contact Name:(Required) First Last Emergency Contact Relationship to Participant:(Required)Emergency Contact Phone Number:(Required)Emergency Contact Alternate Phone Number or Email Address:(Required)PLEASE READ: Camp Rules, Camper Conduct and Parent/Guardian Consent(Required)By checking the box I acknowledge as the adult participant or parent/legal guardian of the above-named participant, I have read and understand the Big Sur Land Trust Camp Rules, Conduct Policy, the Parent/Guardian Consent, the Video/Photo Release, and the Medical Treatment Express Consent. By signing this application, I accept the above rules, have completed the Health Form to the very best of my knowledge and accept, as an adult participant, or do hereby grant permission for my child to attend and participate in all Big Sur Land Trust Youth Outdoor Program activities on the above date(s). I have read and understand the Big Sur Land Trust Camp Rules, Conduct Policy, the Parent/Guardian Consent, the Video/Photo Release, and the Medical Treatment Express ConsentAdult Participant or Parent/Guardian Name:(Required) First Last Adult Participant or Parent/Guardian Email Address:(Required) Adult Participant or Parent/Guardian Phone Number:(Required)Adult Participant or Parent/Guardian Signature for Consent(Required)OPTIONAL PARTICIPANT INFORMATIONHelp us deliver relevant programming and connect more youth to nature, music, and art by sharing the following optional information. Personal identifying information will not be shared. Has the participant attended previous Big Sur Land Trust DAY camps? Please check all that apply: No Yes My sibling(s) has/have If answered "Yes" or "My sibling(s) has/have", please list the year(s):Has the participant attended previous Big Sur Land Trust OVERNIGHT camps? Please check all that apply: No Yes My sibling(s) has/have If answered "Yes" or "My sibling(s) has/have," please list the year(s):Has participant visited a beach, coastal bluffs, coastal town, estuary, slough, etc. before? Yes No If answered "Yes", please briefly describe:What is the participant's gender identity? Female Male Prefer to self-describe Rather not respond Please self-describe here:What is the participant's race/ethnicity? Please check as many as apply: Alaska Native Asian or Asian-American Black or African-American Latino or Hispanic Native American/American Indian Native Hawaiian Pacific Islander White or Caucasian Rather not respond Other If selected "Other" above, please describe:ADDITIONAL HOUSEHOLD INFORMATIONDoes your family spend recreational time outdoors? Yes No If answered "Yes", please tell us how often: Daily Weekly Monthly Yearly What is the primary language spoken at home?Number of people in your household, including you:Estimated MONTHLY household income:What is the best way to communicate future events/opportunities to camp participants and family?Big Sur Land Trust would like to share new information such as seasonal camp job opportunities, upcoming camps, free hikes, community events, and more. How best can we do this? Participant Email Address Parent/Legal Guardian Email Address Other Email Address Other Email Address:
