July 26-29 2017 Register

Register for Trek

This form must be completed together by both the participant and a parent or guardian (if minor). Registrations must be submitted by March 31, 2017.

Personal Information

Parent or Guardian (if minor)


Parental or Guardian Permission and Medical Release

Statement of Responsibility

Medical Information

Medical History

Medications that may be dispensed

  • I agree to abide by all standards as listed in the “For the Strength of Youth” booklet while participating in this Pioneer Trek.
  • I will accept full responsibility for my actions under all conditions.
  • I will wear appropriate and designated trek clothing throughout this Pioneer Trek (including travel time). This will provide a pioneer spirit and physical protection from the elements.
  • I will respect and follow the counsel of all adult leaders.
  • I will abide by any other rules and guidelines set forth for my safety and for the good of the trek.
  • I will work to physically condition myself for trek.
  • I will respect the sacred nature of the historical sites we visit.
  • I will follow applicable “no-trace camping” protocols while on Trek to maintain the historical and wilderness nature of the property.

My parent/guardian and I understand these standards and by entering our names below we agree to follow them. In doing so, I will prepare myself to have a fun and spiritual experience.

  • I understand this Pioneer Trek Youth Conference will be held in a primitive wilderness setting. I also understand that 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 Pioneer Trek Youth Conference 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 Youth Conference which are beyond the control of the Stake staff and Ward leaders, and I agree to personally assume such risks. Proper preparation reduces these risks and is the responsibility of all participants. These considerations should include a warm sleeping bag, warm clothing, a poncho or rain coat, sunscreen, insect repellant, and other items listed on the personal equipment list. I agree to condition myself physically for this experience. Specifically, I will work to be able to complete a minimum requirement of walking/running three (3) miles in 60 minutes or less without undue stress. Also, the Stake staff and Ward 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 Farmington Utah West Stake and its staff and Ward leaders from any and all claims for liability arising from my participation in the Pioneer Trek Youth Conference.
  • I (and/or my guardian) understand this Trek and associated activities will be photographed and video recorded. I/we consent to being photographed and/or recorded while participating in these events and authorize those photographs and recordings to be used, published and/or distributed including through online social media sites (such as youtube, facebook, twitter, blogs, etc).
  • I (and/or my guardian) agree to accept full responsibility for any medical or related expense incurred which are not covered by my own insurance policy. Medical and dental benefits from the Church Activity Insurance Program may be available, but they are secondary to other insurance coverage and subject to limitations. Contact your bishop for plan coverage or a benefit claim form in case of an accident.
  • I (and/or my guardian) agree that in order to partipate in this Pioneer Trek I must commit to stay for the entire duration of the Trek from Wednesday, July 26th through Saturday July 29th as it is the policy of Deseret Land and Livestock to not allow the coming and going of participants except for in a medical emergency.

Note: Parents of youth will be contacted, if at all possible, before securing the medical services of a doctor or hospital in the case of an emergency.

I, the parent or guardian of this youth by entering my name in the field below, declare that I am aware that my youth will be participating in the above designated Stake Youth Pioneer Handcart Trek. I have read and agree to the Statement of Responsibility and have supplied the medical statements above, which are complete and correct. I hereby give my full permission for him/her to participate in this youth trek and authorize the adult leaders supervising this activity to administer emergency treatment for any accident or illness and to 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 as may be deemed necessary or advisable in the diagnosis or treatment of my child. This permission includes travel to and from the youth pioneer trek as well as participation at the trek.

By entering my name in the field below, I agree to act in accordance with the Statement of Responsibility and declare the above statements are complete and correct.

If you marked any of the above items, you must download and fill out the Doctor’s Medical Release Form from this website and have it signed by a medical doctor; you cannot participate without it. (If you did NOT mark any of the above items, you do NOT need a doctor’s visit and additional Doctor’s Medical Release Form.)