June 25 - 28, Boys ages 11 + 12

Please complete the form below

Camper's Legal Name

First Name

Last Name

Camper Birth Date

YYYY

Campers Age

Parent/Guardian/Whom the camper lives with

First Name

Last Name

Phone Number

What county do you live in?

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact other then parent. Name and Phone number

Medical and Medication Authorization

Authorization of Consent for Medical Treatment

By submitting this form I hereby authorize Wilderness Trails to transport the above named camper to a local hospital and give the necessary consent for any treatment, care, diagnosis and/or examination of child in case of emergency.

Is there Medication the your child will need administered while at camp? If yes, please fill out the Medication Log on the home page.

Medical History - Is there any medical history we need to know about?

Photo Release

I hereby give permission to Wilderness Trails to take photographs or voice recordings of campers taken at a camp for any training or public relations purposes (i.e news letters to sponsors, the wildernesstrails.net website, etc.) without further consent. (Children will not be identified)

Wilderness Trails does not receive any government funding and relies solely upon donations to provide these camps.
If you would like to make a donation to WT, we would greatly appreciate it. Wilderness Trails is an Interdenominational Christian camping organization dedicated to “Reaching Out With God’s Love” that shares “For God
so loved the world that He gave his one and only Son, that whoever believes in Him shall not perish but have eternal
life.” John 3:16 



Wilderness Trails is proud to partner with Angel Tree Ministries to offer camp scholarships to qualifying campers. If
you were referred through an Angel Tree partner, or qualify for an Angel Tree scholarship, please be sure to fill out
the scholarship form off of our website. 