Hunter Stake Youth Trek

July 7-9th 2016

Name:______________________________________

Birth Date:_______________

Age:________

Mothers Name:_______________________________ Mothers Cell Phone:__________________________

Fathers Name:_______________________________ _ Fathers Cell Phone:___________________________
Home Address:_________________________________ Parent Email:________________________________
Home Ward:___________________________________ Youths Cell Phone:___________________________

1) I give permission for appropriate photographs and/or videos to be taken of my son/daughter while on trek
to serve as information or publicity for future camps.
2) I testify that all of the information is correct to the best of my knowledge I have described all
physical/emotional problems and or chronic illnesses.
3) I understand that my son/daughter will be participating in physical activities, and I give my permission for
him/her to do so.
4) I understand that my son/daughter is to uphold For the Strength of Youth Standards while participating
in trek.
5) In the event of illness or injury occurring to my son/daughter while attending trek, I consent to medical
treatment considered necessary in the best judgement of the attending physician and performed by or under
the supervision of a member of the medical staff at the hospital/clinic providing medical services. It is
understood that in the event of serious illness or injury, attempts will be made to reach me at the phone
numbers provided on this card. Should my son/daughter be transported to a hospital or clinic, I agree to
meet him/her at the hospital/clinic or send another adult family member to meet him/her there so the youth
leaders can turn him/her care over to a family member.
6) In consideration of the benefits to be derived from participation in trek, I hereby waive any and all claims
or liability again Salt Lake Hunter Stake, The Church of Jesus Christ of Latter-day Saints, and/or any
subdivision thereof, including, youth leaders, officers, or other representative thereof, including persons
working under their directions, arising out of any accident, illness, injury, damage, loss or harm incurred or
suffered by my son/daughter or to his/her property while attending the trek and/or while being transported
to or from trek.
My son/daughter and I have read and understand the above camp liability guidelines and policies
Camper Signature:__________________________________________

Date:_________________________

Parent Signature:__________________________________________

Date:_________________________