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2. Name*
3. Email Address*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
13. Organization Name*
15. Authorized Agents*

    Please list the names of all staff members/volunteers authorized to make reservations on your organization's behalf. 

17. Mission/Program Description*

    Please provide a description of how you/your organization provides services that match the mission of Camp Greilick to expand access to outdoor education and recreation.

19. Upload Supporting Documentation

    Please upload your 501(c)3, mission statement, or other supporting documentation.

20. Upload Certificate of Insurance

    Please upload your organization's certificate of insurance.

22. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree and certify that all information contained in this application is correct.
24. Electronic Signature*
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field