Trek Registration

Registration Deadline

All registration forms must be submitted by May 1, 2026

Participant Information

Full Name *

Date of Birth *

Unit *

Sex *

Address *

City *

State/Province *

Phone Number *

Emergency Contact

Emergency Contact Name *

Primary Phone *

Secondary Phone

Medical Information

Does the participant require a special diet? *

YesNo

Does the participant have any allergies? *

YesNo

List all prescription or over-the-counter medications the participant is currently taking. Leave blank if none.

Can the participant self-administer his or her medication? *

YesNoN/A

If no, please contact Nate Littlefield(email|phone)

Conditions That Limit Activity

Does the participant have a chronic or recurring illness? *

YesNo

Has the participant had recent surgery or a serious illness in the past year? *

YesNo

Identify any other limits, restrictions, or disabilities that could prevent the participant from fully participating in the event or activity.

Other Accomodations or Special Needs

Agreements

I agree to participate in this event: *

I agree to participate in the event and activities listed above (unless noted) and authorize the adult leaders supervising this event to administer emergency treatment to me for any accident or illness and to approve necessary medical care on my behalf. This authorization shall cover this event and travel to and from this event.

Please note: Units may not have the ability to meet all medical, physical, and other accommodations and are asked to counsel with parents or guardians on what is possible.

The participant is responsible for his or her own conduct and is aware of and agrees to abide by Church standards, camp or event safety rules, and other pertinent instructions. The participant's conduct and interactions should abide by Church standards and exemplify Christlike behavior. Parents and participants should understand that participation in an activity is not a right but a privilege that can be revoked if participants behave inappropriately or if they pose a risk to themselves or others.

This information is collected to help event and activity leaders or medical personnel so they can be prepared and appropriately respond to health concerns or an emergency. It will be kept confidential and shared only as needed.

I agree to abide by the rules and requirements of The Nature Conservancy Release of Liability, including: *

I will remain on designated roadways, which may be rough and rocky.
I will keep my distance from any observed wildlife or wildlife habitat such as nests or dens.
I will not remove any plants, flowers or other wildlife from the Preserve.
I will use identified restrooms only, which are located on properties outside of the Preserve.
I will ensure that I leave no waste or trash on the Preserve.

View The Nature Conservancy Release of Liability (PDF)

Signatures

Participant Signature *

Sign below

Printed Name *

Date *