3 States Nature Extravaganza Intent to Register

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The purpose of this form is to gather information needed to determine a prospective participant's eligibility to insure that facilitators can meet the needs of the group so that all have a positive experience

Participant's Name *

If you will be registering another participant(s) on a subsequent form, please list their name(s) here.

Participant's Date of Birth *

YYYY

Guardian's Name (If applicable)

Will you (or the participant) require transportation or desire assistance for carpool arrangement? If so, please state here. *

Contact email address *

Address (if not listed on a primary participant's form)

Phone Number (if not listed on a previous form)

Food Considerations *

Does the participant have any known allergies? *

Has the participant slept away from home before? *

Yes

Other:

Please indicate bunkhouse lodging preference.

Male only

Female only

Co-ed

Private lodging (limited availability)

Clear selection

If you are answering for a minor participant who will be traveling solo, do you have concerns about your child sleeping away?

Yes

Other:

Clear selection

If so, what are they?

Has the participant ever camped before? *

Yes

While at camp, are you willing and able to rideshare on excursions? If so, would you be driving or requesting a ride? *

I will be able to drive and have space for the number of passengers listed below.

I will need help finding a ride, and I am willing to contribute to the driver's expense.

I will be driving only myself and participants I am bringing.

Other:

What questions or concerns do you or the participant have?

How did you find out about the 3 States Nature Extravanganza? *

Submit

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