Registration – Boulder Trek

Step 1 of 6

Eligibility
All youth who are members of the Boulder Stake that will be at least 14 years old on October 1 2022 and are going into high school are invited to attend Trek.
Cost
While the Stake will pay for the majority of all costs for the Trek, we are asking that each participant pay $45 to cover their cost of the food. The payment of $45 should be made directly to your ward by filling out a tithing slip and in the “OTHER” category write in “Trek”.
Deadline

The signup and payment deadline for Trek is Jan 31, 2022. After this date your spot cannot be guaranteed. This applies to all youth and adults attending Trek.
For registration questions contact Rusty Banks at rusty.banks@gmail.com for all other trek questions contact Allen Tracy at allenjtracy@gmail.com .
Who is this form for?*
- I am a parent submitting this form for my youth.
- I am an adult leader submitting this form for myself.
Ward*

Participant's Personal Information
Parent Email Address*

or leaders email if filling out for a leader
Participant Name*
First Last
Participant Phone #
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Gender*
- Male
- Female
Age*
Birth Date*
Month
Day
Year
T-shirt Size*
- x-small
- small
- medium
- large
- x-large
- xx-large
Unisex sizes
Emergency Contact Information
Emergency Contact (parent or guardian)*
Contact's Cell Phone*
Contact's Home Phone

CONTRACT AND RELEASE

I understand this Pioneer Trek will be held in a primitive wilderness setting. I also understand although we will be “roughing it”, so to speak, that the Stake will provide food, restroom facilities, and safe drinking water.

I am voluntarily a participant in this Trek and I will accept full responsibility for my actions under all conditions. I also agree to aid other members of the group in behaving responsibly.

I understand and appreciate that there are inherent risks involved in this Stake-sponsored Trek which are beyond the control of the Stake leaders, and I agree to personally assume such risks. Also, the Stake leaders cannot be held responsible for any injuries or expenses, costs and/or claims in connection with any injuries sustained which were not directly caused by their failure to take due care. I hereby also agree to release the Boulder Colorado Stake and its staff from any and all claims for liability arising from my participation in the Pioneer Trek.

I agree to abide by LDS standards. This means high standards of behavior, honor and all For the Strength of youth Standards are required of me and every participant involved in this Trek.

I agree to accepting the family I am assigned. I will have a willingness to share chores. I will join in trek family activities. I agree to leave all electronic devices at home

STATEMENT OF RESPONSIBILITY

This pioneer Trek will be held in a wilderness setting. We will be “roughing it”, so to speak. The Stake will provide food, restroom facilities, safe drinking water, and learning activities. Each participant in this Stake must act in accordance with church standards at all times, and aid other members of the Stake in behaving in accordance with church standards. There are inherent risks involved in all outdoor activities, including this Stake sponsored Pioneer Trek, which are beyond the control of the Stake staff and officers. Proper preparation reduces these risks and is the responsibility of all participants. These considerations should include a warm sleeping bag, proper clothing, a poncho or rain coat, sunscreen, insect repellent, and other items listed on the personal equipment list. All participants must act in such a way as to not endanger themselves or others, and should show charitable considerations to all other participants and leaders in the Trek. Each participant should condition themselves physically for this experience. More specific requirements will be given.

The Trek will be conducted on public property. Each participant must follow applicable “No Trace Camping” protocols to maintain the wilderness nature of the property. Especially, each participant must avoid littering of any kind.

PARTICIPANT AGREEMENT

I declare that the above statements are complete and correct, and agree to act in accordance with the Statement of Responsibility and I understand and agree to the terms and conditions of the Contract and Release.
Signature of Participant*

Type in your full name to digitally sign this form.
PARENTAL PERMISSION

I, the undersigned, am aware that my youth will be participating in the above designated Stake Pioneer Trek. I have read the Statement of Responsibility and Contract and Release and have supplied the medical information, which are complete and correct. I hereby give my full permission for him/her participation in this Trek and authorize the adult leaders supervising this activity to administer emergency treatment for any accident or illness and act in my stead in approving necessary medical care. In the event any medical attention is needed. I hereby authorize any physicians in charge of my child to administer such medical or surgical treatment or carry out such procedure that may be deemed necessary or advisable in the diagnosis or treatment of my child. The permission includes travel to and from the Trek site as well as participation in the Trek.
Signature of Parent*

Type in your full name to digitally sign this form.

Photo Waiver

For us to be able to post pictures of youth on your Stake blog or any other publication it is Church policy we receive parental permission. Please check one of the following followed by your signature.
Photo Permission*
- I give permission to the Boulder Colorado Stake to post pictures of my youth for Trek publication.
- I do not wish for the Boulder Colorado Stake to post pictures of my youth.
Photo Permission*
- I give permission to the Boulder Colorado Stake to post pictures of me for Trek publication.
- I do not wish for the Boulder Colorado Stake to post pictures of me.

Musical Talents

We are searching for youth who are willing to perform music in front of the entire company during the trek. Please answer the questions below relating to trek-appropriate music and instruments.
Would your youth be comfortable performing a musical solo or in a small group for the Pre/Post trek fireside or during trek?
- Yes
- No
Which instrument(s) would they perform with?
- Voice
- Piano
- Ukulele
- Other
List the other instrument(s) your youth would perform with.
Would your youth be interested in singing in a choir that would perform during trek or the Pre/Post fireside?
- Yes
- No

Step 1 of 6

Eligibility

Cost

Deadline

Participant's Personal Information

Emergency Contact Information

CONTRACT AND RELEASE

STATEMENT OF RESPONSIBILITY

PARTICIPANT AGREEMENT

PARENTAL PERMISSION

Photo Waiver

Musical Talents