Nature Play Camp 2026 Registration Form

Nature Play Camp Camper Registration Form
Please select which week of camp your child will attend:*
Camper Details:
Full Name*

First NameLast Name
Age at Time of Camp:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1
Name*

First NameLast Name
Email*
example@example.com
Address (if same as camper, please type "Same" in first box)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number 1*
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number 2
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number 1
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number 2
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contacts

Please fill in at least one emergency contact--other than a parent--for your camper. In the event of an emergency, parents will be contacted first.
Contact 1 Name*

First NameLast Name
Relation to Camper*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Is this person authorized to pick up your child?*
Contact 2 Name

First NameLast Name
Relation to Camper
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is this person authorized to pick up your child?
Is there any person NOT authorized to pick up your child? If so, please list any names here:*
Is there another adult who IS authorized to pick up your child? Please list any names here:*
Is there anything that you would like camp staff to know about your child before camp begins--for example, learning differences, previous Land Trust or outdoor education experiences, or specific interests that we can highlight during camp?

Medical Information and Waiver

Your child will be spending the day outdoors during Nature Play Camp. The camp will involve walking, climbing, and other physical activities.
Please list any medical conditions, including any requiring maintenance medication (i.e. diabetes, asthma, etc.)*
Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason? If yes, please explain:*
Does your child have any allergies such as food, insects, medication, etc.? If yes, please explain:*
Given the nature of the camp, does your child require any accommodations we can provide? If yes, please elaborate:*
Is there anything else you would like the camp staff to know about your child?
The Land Trust of North Alabama as well as the organizers, leaders, and volunteers of the Nature Play Camp are not responsible for lost or damaged personal property. This is a “rain or shine” camp, but all scheduled events are subject to change or cancellation in the event of severe weather. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders.
Insurance Information
Insurance Provider:*
Name of Policy Holder:*
Policy Number:*
Group Number (if applicable):
Physician Information
Family Medical Provider Name:
Physician's Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
I understand that every reasonable effort will be made to contact me at the contact information I have provided in the event of an emergency. In the event of a medical emergency, and if I or the family physician cannot be reached, I authorize the Land Trust of North Alabama’s camp staff to designate a hospital, physician or emergency personnel to provide care (including hospitalization, if necessary) to the child and release the Land Trust of North Alabama from any liability for injury or harm to the child which may result from this medical care. I understand that responsibility for payment of such medical care will be mine and certify that the child is covered by adequate medical care.
Release of Liability and Use of Image by a Parent/Guardian of Child Participant
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Your child is participating in the Land Trust of North Alabama’s program named above (the “Program”), which will include outdoor experiences. Please read the following and sign below if you approve your child’s participation in the Program as described.

You understand that while governmental and public health authorities are loosening restrictions, COVID-19 is still present in our communities and participating in the Program may put your child at risk of coming into contact with someone infected with COVID-19. The Land Trust of North Alabama continues to take necessary precautions to reduce COVID spread, but no public activity can be 100 percent safe. We ask anyone who is feeling unwell or who has had contact with someone diagnosed with COVID-19 to not participate in the Program until the risk for infection has passed. Unvaccinated persons should continue to wear masks and maintain social distancing, especially when indoors. Program leaders may still require participants to wear masks and/or maintain social distancing during the Program regardless of vaccine status. By participating in the Program, you accept the risk that your child may be injured or come into contact with pathogens, including the COVID-19 virus.
My child is in good health and I am aware of no physical problem or condition that will limit or interfere with my child’s ability to participate in the Program.My child requires the following accommodation or assistance to participate in the Program:
Accommodations/Assistance:
You agree that your child is participating in the activity at your own risk, and acknowledge that The Land Trust of North Alabama has made no warranty or representation, expressed or implied, regarding the safety of conducting the Program.

Your child may be photographed, videotaped or recorded during the Program (“Recordings”). You agree and understand that these Recordings, which may include your child’s image, appearance, voice, name and/or biographical material, may be made and/or produced at the Program. You hereby give the Land Trust of North Alabama permission to use, reproduce, edit, duplicate, broadcast and distribute such Recordings, in any and all media, whether now known or hereafter devised, in perpetuity. Accordingly, you expressly release and hold harmless the Land Trust of North Alabama, its officers, directors, employees, agents, licensees, successors and assigns from and for any and all claims, demands or causes of action which you have or may have for (i) libel, defamation, invasion of privacy or right of publicity arising from the Land Trust of North Alabama’s use of Recordings or (ii) on account for any loss, damage or injury to person or property suffered or incurred by you or your child, in connection with any aspect of your child’s participation in the Program or in any Program-related activity, including any transportation arranged by, paid for or provided by the Land Trust of North Alabama and their employees, officers, directors, volunteers, and representatives.

I further understand there are certain risks and dangers inherent in participating in this event with the knowledge of the dangers that are obvious and/or possibly hidden. I hereby release the Land Trust of North Alabama, and their employees, officers, directors, volunteers and representatives, from any and all liability that may result or arise, directly or indirectly from my child’s participation in this event and associated activities at all Land Trust properties.

This release shall be binding upon you and your heirs, next of kin, executors, administrators and assigns. By signing below, you acknowledge that you have thoroughly read and understand this form and that the statements you have made are all true.

If you have any questions, please feel free to contact Tim Gels at timg@landtrustnal.org or 256-797-7927.
Signature*

Powered by Jotform SignClear
Name of Signee*

First NameLast Name

Final Confirmation and T-Shirt Size Selection*

Camper Registration Fee

Please only select 1 T-shirt; we are limited to one per camper.

$375.00 QuantityT-shirt Size

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Nature Play Camp Camper Registration Form

Parent/Guardian 1

Parent/Guardian 2

Emergency Contacts

Medical Information and Waiver

Insurance Information

Physician Information

Release of Liability and Use of Image by a Parent/Guardian of Child Participant