SAGAMOK FALL HARVEST 2025 - REGISTRATION FORM

Participant/Camper Name Participant/Camper Name First Last
Checkboxes

Checkboxes Male Female
Date of Birth: Date of Birth: / MM / DD YYYY
Home Address:
Mailing Address:
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Messages:
GROUP
How many additional Family/Dependents/Group Members?

How many additional Family/Dependents/Group Members? 1 2 3 4 5 6 7
Name Name First Last
Age
Relationship/Group
Name Name First Last
Age
Relationship/Group
Name Name First Last
Age
Relationship/Group
Name Name First Last
Age
Relationship/Group
Name Name First Last
Age
Relationship/Group
Name Name First Last
Age
Relationship/Group
Name Name First Last
Age
Relationship/Group
TRANSPORTATION, TENT and MEALS


	Yes	No
Do you require meals?	Do you require meals?Yes	Do you require meals?No
Do you require transportation?	Do you require transportation?Yes	Do you require transportation?No
Do you require utilization of a prospector tent for accommodations? Sharing a Tent may be required!	Do you require utilization of a prospector tent for accommodations? Sharing a Tent may be required!Yes	Do you require utilization of a prospector tent for accommodations? Sharing a Tent may be required!No

Please check off day(s) that you will require for TRANSPORTATION, TENT and MEALS:
	Transportatiion	Tent	Breakfast	Lunch	Supper - Only Available on Monday
Monday Oct 6th	Monday Oct 6thTransportatiion	Monday Oct 6thTent	Monday Oct 6thBreakfast	Monday Oct 6thLunch	Monday Oct 6thSupper - Only Available on Monday
Tuesday Oct 7th	Tuesday Oct 7thTransportatiion	Tuesday Oct 7thTent	Tuesday Oct 7thBreakfast	Tuesday Oct 7thLunch	Tuesday Oct 7thSupper - Only Available on Monday
Wednesday Oct 8th	Wednesday Oct 8thTransportatiion	Wednesday Oct 8thTent	Wednesday Oct 8thBreakfast	Wednesday Oct 8thLunch	Wednesday Oct 8thSupper - Only Available on Monday
Thursday Oct 9th	Thursday Oct 9thTransportatiion	Thursday Oct 9thTent	Thursday Oct 9thBreakfast	Thursday Oct 9thLunch	Thursday Oct 9thSupper - Only Available on Monday
Friday Oct 10th	Friday Oct 10thTransportatiion	Friday Oct 10thTent	Friday Oct 10thBreakfast	Friday Oct 10thLunch	Friday Oct 10thSupper - Only Available on Monday

HEALTH CONCERNS
Please state if participant has allergies or medical conditions:
List medications:
Health Card Number:
EMERGENCY CONTACTS
Name Name First Last
Relationship:
Emergency Contact Phone number Emergency Contact Phone number - ### - ### ####
Name Name First Last
Relationship:
Emergency Contact Phone number Emergency Contact Phone number - ### - ### ####
REGISTRATION DEADLINE: Tuesday September 30, 2025 @ 4:30pm
Possession Acquisition License

Possession Acquisition License Yes No
Possession Only License

Possession Only License Yes No
Would you like to volunteer at the Fall Harvest?

Would you like to volunteer at the Fall Harvest? Yes No
List Activity:
RELEASE OF LIABILITY:

RELEASE OF LIABILITY: I acknowledge that I am participating voluntarily in the Sagamok Anishnawbek Fall Harvest. I agree to assume all risk of injury, death, damages, theft and loss to personal property, which may result from my participation in the Sagamok Anishnawbek Fall Harvest. I recognize that loss of property, injury or death could arise from the Fall Harvest activities contemplated by the traditional gathering and the risks normally encountered on the land and water from being out on the land or water may be enhanced by exposure to the elements and other risks inherent in outdoor activities. I retain the right to not participate if I feel the risks are too great on any given day, however, I realize in so doing that I forfeit any claim to Sagamok Anishnawbek. I warrant that I am in good physical and mental health and am physically capable of withstanding the requirements of the Sagamok Anishnawbek Fall Harvest activities
PHOTO & VIDEO RELEASE:

PHOTO & VIDEO RELEASE: I understand and agree that any and all photographs, videos or films taken during the course of my participation in the Sagamok Anishnawbek Fall Harvest which includes me, my name may be used by the Sagamok Anishnawbek Fall Harvest organizers or media without my prior consent and withhold royalties.
It is hereby acknowledged that the contents hereof are fully understood by the Participant (and Parent/Guardian) who agree(s) that same shall be binding upon (his/her/their) heirs, successors, executors, administrators and assigns.
Agree:

It is hereby acknowledged that the contents hereof are fully understood by the Participant (and Parent/Guardian) who agree(s) that same shall be binding upon (his/her/their) heirs, successors, executors, administrators and assigns.
Agree: Yes No
Behaviour Expectations:
In order to make your camp experience as successful as possible, please review our “Fall Harvest Camp Rules”.
PARTICIPANT SIGNATURE:

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Reminder: Child (ren) under the age of 18 years requires Parent/Guardian Signature.
PARENT/GUARDIAN SIGNATURE:

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY
Further information contact:
LRE or Claims and Negotiations Department
(705) 865 – 2421 ext. 550, 551, 401, 113 or 552

SAGAMOK FALL HARVEST 2025 - REGISTRATION FORM

SAGAMOK FALL HARVEST 2025 - REGISTRATION FORM

GROUP

TRANSPORTATION, TENT and MEALS

HEALTH CONCERNS

EMERGENCY CONTACTS

REGISTRATION DEADLINE: Tuesday September 30, 2025 @ 4:30pm

Behaviour Expectations: In order to make your camp experience as successful as possible, please review our “Fall Harvest Camp Rules”.

Further information contact: LRE or Claims and Negotiations Department (705) 865 – 2421 ext. 550, 551, 401, 113 or 552

Behaviour Expectations:
In order to make your camp experience as successful as possible, please review our “Fall Harvest Camp Rules”.

Further information contact:
LRE or Claims and Negotiations Department
(705) 865 – 2421 ext. 550, 551, 401, 113 or 552