Tomahawk Adventure Overnight Registration Personal InformationName* First Last Father's Name* Mother's Name* Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home Phone Number*Phone Number of Parent (emergency use only)*Date of Birth* Month Day Year Parent Email Address* MiscellaneousMedical Insurance Company* Medical Insurance Group Number* Medical Insurance Policy Number* Medical Insurance Phone Number*Electronic Signature for Medical & Photo Release*As the parent or legal guardian of the participant identified on this registration, I hereby delegate authority to the Directors of the "Tomahawk Overnight" to arrange whatever medical treatment they deem necessary for him during the activity. Also, I hereby authorize and consent to the use and reproduction by Sauganash staff or an authorized agent or assignee of any and all photographs taken of my son for the purpose of promoting Sauganash programs, without any compensation to me. All film, together with any prints, shall constitute property of Sauganash, solely and completely. Participant Signature*I understand that there is an expectation of no complaining on The Tomahawk Overnight, and, as a grown man, I am prepared to live up to this expectation. CommentsPlease include any medical or dietary needs.
