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

List company name & policy number.

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

By checking the box above, I understand there are risks to my child(ren) by participating in camp and I voluntarily allow them to participate. I assume full responsibility for any risk or loss, and neither I nor my child(ren) will hold Farmers Union responsible for loss by any cause. I give Farmers Union permission to administer medications per my instructions and to administer or seek emergency health care, and I am responsible for any related costs.

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.

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.