Camp Scholarships | North Dakota Farmers Union

Camper's Name*

First Last

Date of Birth*

Camper's Gender*

Grade finished as of May 2021.*

What county does the camper live in?*

Camper's Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

T-Shirt Size*

Were you referred to NDFU Camp by another youth? If so, who?*

Parent Name*

First Last

Parent E-mail*

Parent Home Phone

Mother's Cell Phone*

Mother's Work Phone

Father's Cell Phone*

Father's Work Phone

Emergency Contact (other than parent)*

List name, phone number(s) and relationship to camper.

Health Insurance*

List company name & policy number.

Medical Issues*

Please list camper allergies, medical issues and/or medications they are taking.

Has your child (children) attended Farmers Union Camp before?*

Yes
No

Which junior camp (grades 3-6) would you be interested in attending?

Which senior camp would you be interested in attending?

June 7-11: Heart Butte (Grades 7-12)
June 28-July 2: Heart Butte (Grades 7-9)
July 12-16: Jamestown (Grades 7-12)
July 26-30: Heart Butte (Grades 10-12)
July 26-30: Jamestown (Grades 7-9)
Aug. 9-13: Jamestown (Grades 10-12)

Busing

Busing to camp is free. List the name of the individual(s) who is/are authorized to transport your child(ren) to and from camp if they are not riding the bus.

Why would you like to send your child (children) to Farmers Union camp?*

Why would you like to be considered for a camp scholarship?*

Farmers Union Assumption of Risk, Release of Liability, and Indemnity*

I Agree

By checking the box above, I understand there are risks to my child(ren) or to me of participating in this event and I voluntarily participate or allow my child(ren) to participate. I assume full responsibility for any risk or loss (including without limitation illness; communicable diseases such as MRSA, influenza, COVID-19; injury; disability; death; or loss or damage to personal property). My child(ren) and I each forever release Farmers Union from liability and responsibility for any risk or loss that may arise out of Farmers Union activities, except to the extent caused by the negligence of Farmers Union or its employees. I give Farmers Union permission to administer medications per my instructions and to administer medications per my instructions and to administer or seek emergency health care, and I am responsible for any related costs.

Media Agreement*

I Agree

By checking the box above, I hereby give my permission to North Dakota Farmers Union to use photographs or video footage of my youth, who is participating in camp activities, for promotional material.

Violations*

I Agree

By checking the box above, I understand that use of alcoholic beverages, tobacco or drugs or other controlled substances during camp is prohibited. Serious violations of the standards of cooperation and good conduct could result in the participant being sent directly home at their own expense and the possible loss of future youth program opportunities.

LAST DAY TO APPLY IS JUNE 6