Wilderness Survival Training

Wilderness Survival Training Adult and Teen Oregon

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Teen Application Form

Lifesong Wilderness Adventures

MM slash DD slash YYYY
Below are a few questions to help us get to know our students a little better. (All student information is confidential and will not be used for any purpose other than providing pertinent information to Lifesong Wilderness Adventures and/or its agents for the sole purpose of determining the suitability of attendance at a Lifesong Wilderness Adventures.)

Previous camping experience is not required to attend Teen Camp. Please fill out and return this form via email or USPS @ Mark Wienert, 73569 Hwy 101, North Bend, OR 97459

Contact phone: 530.859.0539.
Name of Applicant(Required)
Applicant Mailing Address(Required)
Name of Primary Parent/Guardian(Required)
Parent/Guardian Address(Required)
MM slash DD slash YYYY
Gender
Outdoor Camping Experience
Where have you camped?

Are you prepared to experience minor home sickness while away from home?
Do you have any medical conditions that we need to be aware of?(Required)
Would these conditions keep you from participating in strenuous physical activity?(Required)
Are you under the care of a physician?(Required)
Are you under the care of a mental health professional?(Required)
Have you been diagnosed with ADD or similar?(Required)
Are you on medication of any kind?(Required)

Teens enjoy mastering wilderness skills, exploring the rugged landscape, tracking wildlife and experiencing primitive camping. Some students experience minor home sickness and go through technology withdrawal. Most students overcome this in the first few days and become thoroughly engrossed in their outdoor experience.

Mark Wienert is owner and director of Lifesong Wilderness Adventures and is on site for the full duration of camp. As we book a limited number of participants, we urge you to register as early as possible to insure your teens place with us. Our qualified and experienced volunteer staff is hand-picked by Mark. Volunteers and student staff are chosen for their competence, enthusiasm, understanding, and social skills. Our co-ed staff to teen ratio is 1 – 3.

At a Lifesong Wilderness Adventures your teen will experience very few of the amenities you would expect of a traditional summer camp.

Consent(Required)
I/we hereby certify that the information contained herein is true and accurate. I/we understand that to knowingly furnish false information in the preparation of this form may be cause for removal of participant(s) from camp without a refund after registration is accepted.
Signature Method(Required)
You can choose to either use the live signature box or to simply type out your full name to indicate your legal agreement.
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Reset signature Signature locked. Reset to sign again

Lifesong Wilderness Adventures

The Standard in Wilderness Survival Training

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Contact Us

PO Box 149
Blue River, OR 97413
530-859-0539
Monday-Friday: 9 AM – 5 PM PST

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