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THE GREAT “GOT NATURE?” FAMILY CAMPOUT at Fort Missoula Information & Registration Form “Got Nature?” Free Event Hosted By: Missoula Children & Nature Network Things to Know: Camper Types: This event is intended for first-time/beginner campers. Others are welcome as mentor campers. Mentor campers may help other campers with basic tasks including set-up, clean-up and meal preparation. Check the appropriate box on the form below. Chaperone Requirements: All children require an accompanying adult. One adult per three kids aged 6 and up and one adult per two kids ages 5 and under. List all participants below on the group identification form. Event Schedule: The camp-out will begin on Saturday Sep. 19th, with arrival, sign-in and camp set up taking place be- tween 2pm and 3pm. The afternoon and evening will be filled with activities, camp games, apple press- ing, dinner, and camp fire entertainment. The event will include breakfast on Sunday, followed by camp clean-up and departure by 10am. Location: Camp Headquarters and tent city will be located by the Historical Museum. (Bldg. 322 Fort Missoula) Provided Equipment: MCNN is able to provide a limited number of tents, and sleeping pads. Ask neighbors, friends, and fam- ily before requesting equipment below. Remember that food and cooking equipment, water, and rest- rooms will be provided. Equipment To Bring: Tent and pad (if not requesting them), sleeping bag or adequate blankets, pil- low, camp chair (if wanted), plate and/or bowl and utensils, water bottle, appropriate clothing for the weather, and a favorite camp game. EACH PARTICIPANT MUST HAVE A SIGNED LIABILITY WAIVER TO PARTICIPATE IN THE PROGRAM Hop on over to the next page Registration Due By: Sept. 11th ---PAGE BREAK--- Group / Family Phone Number: Cell: Please list all campers in group: Waiver Full Name Age Signed 1. 2. 3. 7. 4. 6. 5. 8. Suggested Gear Checklist: Flashlight Warm Hat Toothbrush & paste Gloves Pillow Warm Pants Sleeping bag or warm blanket(s) Short & Long Sleeve Shirt Water bottle Fleece sweatshirt Snacks Jacket Got Nature Passport Books Shoes or boots Bug dope Extra pair of socks Any regular taken medications Sunscreen Towel or Washcloth Sunglasses Clothing Tips Dress in layers so you can add or take away clothing to keep dry. Any fabric is a better choice than cotton. Cotton is not a recommended camping fabric (If it rains, cotton is hard to dry, and cold when wet). Remember: You can never be too prepared!! Cut along line and mail Group Form to: Parks & Recreation Dept., 600 Cregg Ln., Missoula, MT 59801 Camper Type: ____Beginning Camper ____Mentor Campers I do need to Borrow Gear: (quantity of each) ____Tent (4-person tent) Sleeping Pads I do NOT need Gear—I have my own Tent/Sleeping Pads Food: Menu is meat, spuds, eggs, bagels, fruit, nuts, peanut butter, jam & veggies. If your dietary requirements are different that what is being provided…….please plan to bring your own food. Group Identification FORM Please print clearly ---PAGE BREAK--- The Great “Got Nature?” Campout At Fort Missoula Missoula Children & Nature Network LIABILITY RELEASE FORM — TO BE TURNED IN AT THE EVENT Each individual must complete a liability form, if under 18 a parent or legal guardian must sign the liability form. ACKNOWLEDGEMENT OF INHERENT RISKS, WAIVER, RELEASE OF ALL CLAIMS AND HOLD HARMLESS AGREEMENT FOR MISSOULA CHILDREN & NATURE NETWORK (MCNN) PLEASE READ THIS FORM CAREFULLY, and be aware that, in signing up and participating in a Missoula Children’s & Nature Network (MCNN) programs, you will be waiving and releasing all claims for injuries, arising out of these pro- grams, that you or the other named participant might sustain. The terms "me", and "my" also refer to parents or guardians as well as participants in the programs. In registering for these programs, you are agreeing as follows: Outdoor programs are by definition, fraught with risks. A prudent program does all it can to deal in perceived risks and to reduce (but not eliminate) the real risks, by the use of accepted industry safety procedures. I affirm my understanding of the following about MCNN programs. I understand that they are conducted in an outdoor setting, and there are natural risks inherent to such programs. These risks include but are not limited to, tripping or fal- ling, having an allergic reaction to plants or insect bites, personal injury or fatality due to nature of activity, injury due to inclement weather or in the case of wilderness trips, suffering any type of accident or illness in remote areas without easy access to medical facilities, or while traveling to and from the activity site. I understand I will be participating as part of a group in activities of varying physical degree and that these endeavors involve strenuous exertion. I further understand and agree that the terms such as "participation", "programs" and "activities", referred to in the Agreement, include all exercises and physical movements of any nature while I am participating in these programs and further include the provisions of or failure to provide proper instructions of my use of the services, facilities, or premises involved in these programs, and transportation to and from events. I agree to follow all instructions and guidelines given by them, and to act in a safe and responsible manner toward all participants and the environment. I understand that I am required to disclose any and all medical problems I have that might inhibit my ability to participate in the program of my choice. I further guarantee that I will not be under the influ- ence of drugs or alcohol during the time I am taking part in a MCNN program. I DO NOT WISH MCCN TO USE MY likeness or picture, or that of my child, in any photograph/video for advertising or promotion of the MCNN Programs. I fully comprehend and willingly assume the responsibilities and risks of participating in this program, as outlined in the orientation information and incorporate any subsequent instruction into this agreement. BY SIGNING BELOW, I AGREE TO FULLY ABSOLVE MISSOULA CHILDREN & NATURE NETWORK, ALL ITS SPONSORS OR VOLUNTEERS, FROM ALL LIABILITY FOR ANY DAMAGES, INJURIES, OR LOSSES WHICH MIGHT BE SUSTAINED WHILE PARTICIPATING IN THIS PROGRAM. Participant signature Date Parent or guardian MUST sign if Participant is under the age of 18 Date **PLEASE COMPLETE HEALTH HISTORY AND FIRST AID RELEASE ON BACK OF THIS FORM** ---PAGE BREAK--- HEALTH HISTORY NAME: DATE OF COURSE: MC&NN CAMPOUT @ FT MISSOULA DATE OF COURSE: SEPT. 19 - 20, 2009 WE REQUIRE FULL DISCLOSURE OF YOUR CURRENT HEALTH. THE INFORMATION YOU PROVIDE MAY AS- SIST PEOPLE IN THE UNLIKELY EVENT OF AN ACCIDENT. THEREFORE, BEFORE YOU FILL THIS FORM OUT, PLEASE READ IT CAREFULLY. FULL AND ACCURATE COMPLETION OF ALL SECTIONS IS VERY IM- PORTANT. IN CASE OF EMERGENCY, PLEASE CONTACT: Relationship: Home Phone: Cell Phone: PLEASE LIST ALL INFORMATION REGARDING THE FOLLOWING: All known allergies: Disabilities: Heart Conditions: Phobias or Fears: Past Injuries/Illnesses/Seizures and Dates: Past Operations and Dates: Current Medications: Do you wear glasses/contact lenses? y/n Please list any other medical information or history that would be important for us to know: IF PARTICIPANT IS UNDER THE AGE OF 18, PARENT/GUARDIAN MUST COMPLETE THE SHADED BOX Doctor's Doctor's Phone: Doctor's Address: Insurance Policy: Group Number: Blood Type: PERMISSION TO RECEIVE FIRST AID & TO SECURE MEDICAL HELP I am sufficiently fit to participate in this program. I have completed health history information that is accurate, complete, and true to the best of my knowledge. I agree to notify the program facilitator(s) of any changes to my health and fitness, which may occur before or during the program. Should I become ill or injured, I give permission for the program facilitator(s) to render first aid and to seek emergency medical or rescue services, as they see fit and at my cost. Signature (If under 18 parent or guardian must sign): Print Name: PLEASE SIGN WAIVER ON FRONT OF THIS FORM TO COMPLETE REGISTRATION