Register - Camp Nahshii

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Camp Nahshii 2022
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:

Jr. & Sr. High Camp: Campers must be in Fort Yukon NO LATER THAN 3:00 PM on June 20th. Returning flight must be set for AFTER noon on July 1st.

* Indicates required field

Select which camp you are registering for: *

Jr. & Sr. High (June 20th - July 1st)

Camper Information:

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

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 Asthma? *

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 concerns or conditions that are not mentioned above, 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

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