Parent/Guardian Full Name
* Parent/Guardian Full Name
* Mailing Address
* Cell Phone
* Home/Alternate Phone
Camper's Full Name
* Camper's Full Name
Grade level as of Fall 2017
Camper Personal Statement
Please describe what attending the Jack Creek Preserve camp would mean to you.
Parent Personal Statement
Please describe how your student will benefit from attending the Jack Creek Youth Camp.
Need for Scholarship
Please provide information relevant to your family situation that qualifies you for a camp scholarship (illness, divorce, special needs, etc)
Are you seeking a full or partial scholarship
Partial Scholarship statement
If seeking partial, scholarship what amount do you or your child plan to contribute? We encourage kids to help pay for their camp experience.
Do you qualify for additional financial assistance programs? If so please describe. In none, state none.
Please feel free to add any additional information you feel may be helpful to our application review.
Has your camper attended camp at Jack Creek Preserve before?
Is your camper interested in receiving the Bow Hunter Certification (July Camp Only)?
Will your child bring their own bow?
Please tell us about your interests. Select all that apply.
Cast Iron Cooking
Please tell us about your interests.
Please tell us a few of your interests such as archery, hiking, fly fishing, cast iron cooking, plants, photography, orienteering, weed identification, first aid or any other outdoor activity.
Does your camper have any allergies? If yes, please describe.
Is your camper on any medications? If yes, please list.
How did you hear about the Jack Creek Preserve Summer Camps?
T-shirts are adult size.
The undersigned Parent or legal Guardian agrees to to the terms of this waiver and release of liability (“Agreement”), including the general waiver and release of liability described below and agree to be bound by the following: Identification of Risks: I fully understand that my child’s participation in or observation of the Activity means that my child will be in an outdoor setting as an integral part of participation in the Activity. My child may be participating in or observing activities including, but not limited to: archery, hiking, biking, climbing, fly-fishing, horseback riding, horse safety and care, wildlife identification and tracking, on‐site water sampling of creeks and lakes, plant identification and natural history, geology education, terrain navigation, wilderness survival skills, art, astronomy. Any of these Activities may, by their nature, expose my child to a variety of known inherent risks and dangers, including the inherent risk of serious bodily injuries, death and property damage, which injuries and damage could arise out of his or her own actions or inactions, those others participating in the Activity, the weather or other conditions in which the Activity takes place, his or her health conditions, the structure or maintenance of any facilities used in connection with the Activity and equipment used in connection with the Activity. I also fully understand that all risks are not apparent, knowable or foreseeable. I acknowledge that use of protective equipment such as helmets and life jackets have benefits that may reduce or mitigate the severity of injuries to my child, but use of protective equipment is not a guarantee of safety. Assumption of Risk: I hereby knowingly and voluntarily assume all risks, known and unknown, relating to the Activity, including the risks of serious bodily injuries such as permanent disability, paralysis or death and agree to be responsible for any and all injuries, damages, costs, expenses and other losses that could arise at any time as a direct or indirect result of my child’s participation in or observation of the Activity. Waiver and Indemnification: Aware of the risk and willing to assume them, I for my child, myself, my heirs, executors, administrators, legal representatives, assigns and successors in interest (“Representatives”), to the fullest extent permitted by law, hereby release to the fullest extent permitted by law, hereby release Jack Creek Preserve Foundation, and each of its affiliated or parent companies, subsidiaries, officers, directors, members, managers, employees, agents, guides, trainers, doctors, officials, organizers, concessionaires, volunteers or sponsors ( collectively, the “Released Parties” or “Providers”) from any and all claims by me, my child, or my Representatives in any way connected with my child’s preparation for and/or participation in or observation of the Activity, both in law and in equity, in any way arising out of or resulting from damage to property or personal injury, conscious suffering, or death sustained by me, my Representatives or my child. Release from liability includes loss, damage, or injury resulting from intentional acts, failure to act, negligence, or any other cause or causes; except where caused by the gross negligence or willful or wanton misconduct of any of the Released Parties. This waiver and release shall bind me, my Representatives, my child any and all relatives, personal representatives, heirs, beneficiaries, next of kin, subrogees or assigns who might pursue any legal action or claim on my child’s behalf. I on behalf of myself, my Representatives and my child further agree that I WILL DEFEND, INDEMNIFY AND HOLD HARMLESS the Released Parties against all claims, demands and causes of action, including court costs and reasonable attorneys' fees, directly or indirectly arising from any action or other proceeding brought by or prosecuted contrary to this Agreement for the benefit of me or my child. This Agreement extends to all claims of every kind and nature whatsoever, whether known or unknown. Emergency Medical Care: I verify that my child has no past or current physical condition that might affect their participation in Activity. In the event my child is in need of emergency medical treatment, I hereby authorize any medical care provider to carry out first aid or any emergency medical care and I accept responsibility and agree to indemnify the Released Parties for all such medical care and expenses. Applicable Law: This waiver and release shall be governed by Montana Law and exclusive jurisdiction for any such claims shall be in State District Court in Madison County, Montana, or in a Federal District Court in Montana. Severability: A determination of invalidity of any one or more of the provisions or conditions hereof by judgment, order or decree of a court shall not affect in any manner the other provisions hereof which shall remain in full force and effect. THIS AGREEMENT SHALL BE EFFECTIVE UNTIL TERMINATED IN WRITING BY JACK CREEK PRESERVE FOUNDATION
Please check the box below to agree to our Waiver and Indemnification
During Jack Creek Preserve Foundation events, photos or videos of attending youth are often taken for use in promotional materials for the Preserve. Neither your childs name nor any other identifying information will be made available in any way.The Jack Creek Preserve Foundation is currently hosting a Montana Conservation Corps (MCC) member as a part of their staff. Therefore, photo and video media taken at the Jack Creek Preserve may be shared with the Montana Conservation Corps.The participant and guardian do hereby give full consent to both the Jack Creek Preserve Foundation as well as the Montana Conservation Corps to copyright or publish all videos and photographs in which the participant may appear. The participant and guardian do hereby understand that MCC is a highly visible program within the community and media eye, and hereby give consent for release of all video and photographic materials and waive any right to inspect or approve of the finished product.
Please check the box below to give photography permission.
Signature of Parent/Legal Guardian