Name and Ages of Campers

Names and Ages of Campers in your group

(Limit of 8 individuals per camp site)

Our County EMS has requested, In case of emergency

1)_____________________________________________2)______________________________________________

3)_____________________________________________4)______________________________________________

5)_____________________________________________6)______________________________________________

7)_____________________________________________8)______________________________________________

*If participant is under 18 years old, Parent or Guardian must sign Below: The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child participation in the Event, and has agreed individually and on behalf of the child, to the terms of the waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to in THE WAIVER AND RELEASE OF LIABILITY. Loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and parents or legal guardian.

**NO dumping of holding tanks is allowed on the property.

Credit card will be kept on file to cover any loss and or damage from any campers in your party. No additional charges will be assessed before speaking to and acknowledging to the Camper/parties involved.

_________________________________________     ___________________________________   ____________

Printed Name                                                                  Signature                                                          Date

Campers and their group will not be permitted to property without this signed form on file.