Northland Family Registration Form

Northland Family Registration Form

family camp form Form Preview
Northland Family Registration Form
  • Northland Camp Family Registration

  • Camper Information
    One family per form

  •  -
  •  -
  •  -
  • Other Family Members Registering

    Spouse or children attending with parents

  • Discounts

  • Camp & Payment Information

  • Your registration is complete when you submit this completed form and pay the $200 non-refundable, limited transferrable registration fee. You have two payment options; please check which one you plan to use. Fee must be paid within 5 business days to keep your reservation.

  • Participation, Release, and Medical Agreement

    While we make every effort to provide a safe and pleasant environment for every camper who attends Northland, we do require that this participation agreement be read, filled out, signed, and dated by all campers (or their parent/guardian if under the age of 18) who wish to participate in activities at Northland.

    With full knowledge, I accept full responsibility for any injury or accident that may occur to myself, my spouse, or my child while participating in Northland activities. I give permission for my child to participate in activities that occur at Northland. These activities may include, but are not limited to, swimming in the lake, canoeing, high ropes course, archery, riflery, paintball, and strenuous competition games.

    Although Northland has taken reasonable steps to provide equipment and skilled employees so yourself, your spouse, or your child can participate in activities for which he/she may not be skilled in, we do remind you that these activities are not without risk. Certain risks cannot be eliminated due to our camp’s rural setting and without destroying the unique character of those activities. The same elements that contribute to the character of these activities can be cause of loss or damage to your property, accidental injury or illness or, in extreme cases, permanent trauma or death. We do not want to frighten you or reduce your enthusiasm for these activities, but we do think it is important for you to be informed and know in advance about inherent risks.

    For promotional or marketing purposes, Northland reserves the right to use any audio, video, and/or photography of guests or campers participating at Northland facilities.

    I, on behalf of myself, my children, my assigns and my estate, agree to release and hold harmless Northland, its officers, board, agents or employees, for any and all claims for injuries, causes of action, or liability related to my child’s participation in any activity occurring at Northland . This release does not apply to intentional and/or willful acts of misconduct by Northland or any of its officers, board, agents or employees.


    By checking below, I acknowledge that if anyone is hurt or property damaged during my or my child’s participation in these activities, I and/or my child may be found by a court of law to have waived any right to maintain a lawsuit against Northland on the basis of any claim which has been released herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and agree to be bound to its terms.

  • Medical Information

  • I give permission for myself or my child to attend camp at Northland. I understand that my personal insurance will provide primary coverage for medical aid and that Northland will provide excess coverage. I also understand that if myself or my child must be sent home because of disciplinary or other problems, I will assume the additional transportation cost. IN CASE OF MEDICAL EMERGENCY, I hereby give permission to the physician selected by the camp director or his agent to hospitalize, secure proper treatment for, and order injection, x-ray, anesthesia, or surgery for myself or my child as named previously.

    Myself or my child is immunized against the following according to H.E.W. standards: Polio, Measles, Mumps, Rubella, Diphtheria, Tetanus, and Whooping Cough. (Please notify the camp if this child has been exposed to any communicable disease during the two weeks prior to camp attendance.)

  • Acknowledgement

    By checking below, I am acknowledging that I agree with the above Participation, Release, and Medical Agreement and Medical Information. My acknowledgment is equally as binding as signing a paper copy of the agreement.

    Parent/Guardian required for those under 18

  • Heading

  •    
  • Should be Empty: