Jr. High Registration - Camp Nahshii

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Camp Nahshii 2019
Student Registration:

NOTE: Camp Nahshii is free to campers. We provide transportation to and from Camp Nahshii and Fort Yukon. Transportation TO Camp Nahshii will be provided FROM Fort Yukon on these dates:

KIDS Camp: July 5th - 7th (CLICK HERE TO REGISTER FOR KIDS CAMP)

Jr. & Sr. High Camp: July 21st - 31st.
Campers must be in Fort Yukon NO LATER THAN 3:00 PM on July 21st. Returning flight must be set for AFTER noon on July 30th.

Camper Information:

* Indicates required field

Student Name *

First

Last

Student Email *

Student Phone Number *

Grade: *

Parent/Guardian Information:

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Medical Information:

Medical Insurance Policy Name: *

Policy ID or Number: *

Primary Clinic *

Have you had an injury requiring medical attention in the past year? *

Yes No

Do you have any allergies? *

Yes No

Do you have Asthma? *

Yes No

If you have Astham, do you have an inhaler? (If no, skip) *

Yes No

Do you have any medical conditions that require treatment or medication? *

Yes No

Are you currently taking any prescription or non-prescription medications? *

Yes No

Do you have any heart conditions? *

Yes No

Do you have any conditions which may limit participation in camp activities? *

Yes No

If you answered "yes" to any of the questions above, please explain below. Also, please include any medical conditions, such as special dietary needs or restrictions: *

Please provide immunization history below. Include the kind and dates of immunizations (DTP, TD or TDAP, MMR, etc.). Also, indicate positive or negative for TB: *

Medical/Dental Consent:

Release:

Parent/Legal Guardian Signature (Note: Your first name, middle initial, and last name typed here will be treated as a writen signature): *

Submit

See You At Camp Nahshii 2019

Home
Register
- Jr. High Registration
- KIDS camp registration
Contact