Grand Canyon Youth

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For more information 928.773.7921

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Why GCY
Expeditions
Stories & Photos
Ways to Give
- Donate
- Merchandise
News & Events
About Us
The Ripple Effect

Youth Application

Hidden Fields
Civi Event ID
This is autopopulated from the eid url parameter invoking this form.
Waitlist?
- Waitlist?
Financial Aid Available for Event?
- Is FAID event
**Travel Requirement**
In order to mitigate exposure to COVID-19, in the event that a participant is evacuated from an expedition we require an adult responsible for each participant to be within five driving hours of Flagstaff, AZ for the duration of the expedition. GCY will facilitate communication efforts with this adult in the event of an evacuation.
For the duration of the expedition,*
- My school/organization will provide a contact.
- The following adult has agreed to be the contact.
Adult Contact Name*
First Last
Adult Contact Primary Phone*
Adult Contact Additional Phone
Relationship to Participant*
School/Organization*
If not covered by a school/organization, I confirm that the above adult has been notified, and has willingly accepted this responsibility for the duration of the expedition.
Participant Signature*
Parent/Legal Guardian Signature*
Parent/Guardian Initials*
Participant Information

This Expedition is full; however, you can apply now to be added to the waiting list. If a spot becomes available we will contact you. Thank you for your interest. You can contact us at [email protected] or 928.773.7921 with any questions.
Participant Name*
First Last
Preferred Name/Nickname (If not listed above)
Pronouns*
Participant Address*
Mailing Address City State ZIP Code
Participant Email*
Participant Date of Birth*
MM
DD
YYYY
Participant Primary Phone*
Participant Additional Phone
School/Organization
Participant Race/Ethnicity*
- Asian
- Black or African American
- White
- Hispanic/Latinx
- American Indian or Alaska Native
- Native Hawaiian or Pacific Islander
- Other
- Prefer Not To Say
Parent/Legal Guardian 1
Relationship to Participant*
Parent/Legal Guardian 1 Name*
First Last
Guardian Gender
- Male
- Female
- Other
Parent/Legal Guardian 1 Primary Phone*
Parent/Legal Guardian 1 Additional Phone
Same Address As Participant?*
- Yes
- No
Parent/Legal Guardian 1 Address*
Mailing Address City State ZIP Code
Parent/Legal Guardian 1 Email*
Parent/Legal Guardian 2
Relationship To Participant
Parent/Legal Guardian 2 Name
First Last
Parent/Legal Guardian 2 Primary Phone
Parent/Legal Guardian 2 Secondary Phone
Same Address As Participant?
- Yes
- No
Parent/Legal Guardian 2 Address
Mailing Address City State ZIP Code
Parent/Legal Guardian 2 Email
Alternate Emergency Contact
Grand Canyon Youth will only contact an Alternate Contact after first attempting to connect with the parents.
HIDDEN 2021- Alternate Emergency Contact Name*
First Last
HIDDEN 2021- Alternate Emergency Primary Phone*
HIDDEN 2021- Alternate Emergency Contact Additional Phone
HIDDEN 2021- Alternate Emergency Contact Additional Phone
HIDDEN 2021- Alternate Emergency Contact Relationship to Participant*

Participant Health Information
As parent/guardian, GCY relies on you to provide thorough and accurate information about your child’s health history. Your child is traveling to a wilderness area and may be more than 24 hours away from definitive care. It is important that you advise GCY of any changes to your child’s medical condition prior to their expedition. GCY guides have wilderness first aid training (WFR), but they are not medical professionals. The confidential information provided in this form is shared only with applicable parties and program staff.
Participant Height*
(e.g. 5' 6")
Participant Weight*
(e.g. 110 lbs) - estimate is ok
Participant Sex Assigned at Birth*
- Male
- Female
- Intersex
- Not Listed
Has the participant been camping?*
- Never
- A little
- A lot
Participant's swimming ability*
- None
- Fair
- Good
- Excellent
Medical History
Has the participant ever been diagnosed with any of the following conditions?
- Heart Condition
- Diabetes /Hypoglycemia
- High or Low Blood Pressure
- Migraines / Severe Headaches
- Seizures / Epilepsy / or other Neurological Disorder
- Serious Head Injury
- Urological Condition/ Reoccurring UTI
- Anemia / Blood Disorder
- Musculoskeletal Disorder/Arthritis
- Anaphylaxis / Severe Allergic Reaction
- Hay Fever / Seasonal Allergies
- Asthma / Respiratory Condition
- Gastrointestinal Condition
- Food Allergy/Intolerance (Non-Anaphylactic)
- Pregnancy
- Sleep Disorder / Sleepwalking / Night Terrors
- Developmental Disability or Delay
- Depression / Anxiety
- Attention Deficit/Hyperactivity Disorder
- Emotional / Psychiatric Disorder or Concern
- Substance Abuse (drugs, tobacco, alcohol)
- Eating Disorder
- Self-Harm Behaviors
Heart Condition
What specific condition does your child have?*
When was your child diagnosed?*
Does your child currently (within the last year) see a specialist for their condition?*
- Yes
- No
What impact does this condition have on your child’s day to day health?*
What are any causes, triggers, or signs of onset?*
If a flare up / episode occurs, what is the recommended response?*
Are there any recent changes to your child’s condition?*
How many times in the last 12 months has your child visited urgent care, the ER, or a hospital due to this condition?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and/or their condition?*
Diabetes / Hypoglycemia
What specific condition does your child have?*
When was your child diagnosed?*
Does your child currently (within the last year) see a specialist for their condition?*
- Yes
- No
What impact does this condition have on your child’s day to day health?*
What are any causes, triggers, or signs of onset?*
Does your child require nighttime monitoring or experience hypoglycemic episodes while sleeping?*
If a flare up / episode occurs, what is the recommended response?*
Are there any recent changes to your child’s condition?*
Has your child required pediatric ICU treatment for their condition?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and/or their condition?*
Please provide your child’s care plan to [email protected].
High or Low Blood Pressure
What specific condition does your child have?*
When was your child diagnosed?*
Does your child currently (within the last year) see a specialist for their condition?*
- Yes
- No
What impact does this condition have on your child’s day to day health?*
What are any causes, triggers, or signs of onset?*
If a flare up / episode occurs, what is the recommended response?*
Are there any recent changes to your child’s condition?*
How many times in the last 12 months has your child visited urgent care, the ER, or a hospital due to this condition?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and/or their condition?*
Migraines / Severe Headaches
What specific condition does your child have?*
When was your child diagnosed?*
Does your child currently (within the last year) see a specialist for their condition?*
- Yes
- No
Please describe your child’s symptoms. How frequently do they occur?*
What impact does this condition have on your child’s day to day health?*
What are any causes, triggers, or signs of onset?*
If a flare up / episode occurs, what is the recommended response?*
Are there any recent changes to your child’s condition?*
How many times in the last 12 months has your child visited urgent care, the ER, or a hospital due to this condition?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and/or their condition?*
Seizures / Epilepsy / or other Neurological Disorder
What specific condition or types of seizures does your child have?*
When was your child diagnosed?*
Does your child currently (within the last year) see a specialist for their condition?*
- Yes
- No
Please describe your child’s symptoms. How frequently do they occur?*
What are any causes, triggers, or signs of onset?*
Does your child have a post-ictal state after a seizure?*
What impact does this condition have on your child's day to day health?*
If a flare up / episode occurs, what is the recommended response?*
Are there any recent changes to your child’s condition?*
How many times in the last 12 months has your child visited urgent care, the ER, or a hospital due to this condition?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and/or their condition?*
Serious Head Injury
Describe the injury, when it occurred, and how it was treated.*
Does your child currently (within the last year) see a specialist for their condition?*
- Yes
- No
Does your child have any persistent problems from this injury?*
Is there anything else that we should know about your child and/or their condition?*
Urological Condition/ Reoccurring UTI
What specific condition does your child have?*
When was your child diagnosed?*
Does your child currently (within the last year) see a specialist for their condition?*
- Yes
- No
What are any causes, triggers, or signs of onset?*
If a flare up / episode occurs, what is the recommended response?*
Are there any recent changes to your child’s condition?*
How many times in the last 12 months has your child visited urgent care, the ER, or a hospital due to this condition?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and/or their condition?*
Anemia / Blood Disorder
What specific condition does your child have?*
When was your child diagnosed?*
Does your child currently (within the last year) see a specialist for their condition?*
- Yes
- No
What impact does this condition have on your child’s day to day health?*
If a flare up / episode occurs, what is the recommended response?*
Are there any recent changes to your child’s condition?*
How many times in the last 12 months has your child visited urgent care, the ER, or a hospital due to this condition?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and/or their condition?*
Musculoskeletal Disorder/Arthritis
What specific condition does your child have?*
When was your child diagnosed?*
Does your child currently (within the last year) see a specialist for their condition?*
- Yes
- No
What impact does this condition have on your child’s day to day health?*
What are any causes, triggers, or signs of onset?*
If a flare up / episode occurs, what is the recommended response?*
Are there any recent changes to your child’s condition?*
How many times in the last 12 months has your child visited urgent care, the ER, or a hospital due to this condition?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and/or their condition?*
Anaphylaxis / Severe Allergic Reaction
Please list your child’s allergen(s):*
What specific condition/allergy does your child have?*
When was your child diagnosed?*
HIDDEN-Does your child currently (within the last year) see a specialist for their condition?*
Does your child currently (within the last year) see a specialist for this condition?*
- Yes
- No
What happens when your child is exposed to the allergen? (Reaction & timing)*
How well does your child manage their allergy?*
What was the date of their last allergic reaction? Did this incident result in a trip to urgent care, the ER, or hospital?*
How many times in the past year has your child visited an urgent care, ER, or hospital due to this condition?*
Is your child prescribed epinephrine or an inhaler for this allergy? Do they know how to use these medications? (If yes, please note your child must bring two sets on the expedition, and keep one set on them at all times)*
If exposed, what is your recommended response? (Medication, care, treatment sequence)*
Is your child’s allergy related to food?*
- Yes
- No
Can your child eat food that has been processed in a facility that also processes their allergen?*
Can airborne particles or skin contact trigger this reaction?*
What do you do at home or school to prevent / reduce exposure? Do you have this allergen in your home?*
Is your child able to self-advocate, read labels, ask questions, and be aware of what they’re eating?*
Would your child like to bring a few special food items along for the program (ie. favorite nut-free spread)?*
Is there anything else that we should know about your child and/or their condition?*
If you would like to see a menu or are considering providing supplemental food/snacks please contact us at [email protected] to make arrangements.
Asthma / Respiratory Condition
What specific condition does your child have?*
When was your child diagnosed?*
Does your child currently (within the last year) see a specialist for their condition?*
- Yes
- No
What impact does this condition have on your child’s day to day health?*
What are any causes, triggers, or signs of onset?*
If a flare up / episode occurs, what is the recommended response?*
Are there any recent changes to your child’s condition?*
How many times in the last 12 months has your child visited urgent care, the ER, or a hospital due to this condition?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and/or their condition?*
Gastrointestinal Condition
What specific condition does your child have?*
When was your child diagnosed?*
Does your child currently (within the last year) see a specialist for their condition?*
- Yes
- No
Please describe your child’s symptoms. How frequently do they occur?*
What impact does this condition have on your child’s day to day health?*
What are any causes, triggers, or signs of onset?*
If a flare up / episode occurs, what is the recommended response?*
Are there any recent changes to your child’s condition?*
Is there anything else that we should know about your child and/or their condition?*
If you would like to see a menu or are considering providing supplemental food/snacks please contact us at [email protected] to make arrangements.
Food Allergy / Intolerance (Non-Anaphylactic)
If your child has been prescribed an EpiPen or hospitalized for this allergy, please select "Anaphylaxis / Severe Allergic Reaction" and answer those questions.
HIDDEN - Please list your child’s food allergen(s):*
What specific food allergy/intolerance does your child have?*
When was the allergy diagnosed?*
What happens when your child ingests the allergen? How severe is the reaction?*
If exposed, what is your recommended response? (Medication, care, treatment sequence)*
How many times in the last 12 months has your child visited urgent care, the ER, or a hospital due to this allergy?*
Can your child eat food that has been processed in a facility that also processes their allergen?*
What do you do at home or school to prevent/reduce exposure? Do you have this allergen in your home?*
How well does your child manage this allergy? Are they able to self-advocate, read labels, ask questions, and be aware of what they’re eating?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and/or their condition?*
If you would like to see a menu or are considering providing supplemental food/snacks please contact us at [email protected] to make arrangements.
Pregnancy
Is your child currently pregnant?*
Sleep Disorder / Sleepwalking / Night Terrors
What specific condition does your child have?*
How often does this happen?*
Please describe your child’s symptoms.*
What are any causes, triggers, or signs of onset?*
Have they ever harmed themselves with their sleep condition?*
Is there anything else that we should know about your child and/or their condition?*
Developmental Disability or Delay
What specific condition does your child have?*
When was your child diagnosed?*
Does your child have any physical or communication limitations?*
Please describe your child’s condition. Do you have any concerns about their participation?*
What techniques are most successful in supporting your child? (e.g. de-escalation interventions)*
Is there anything else that we should know about your child and their condition?*
Depression / Anxiety
What specific condition does your child have?*
When was your child diagnosed?*
What are your child’s symptoms? (e.g. withdrawn, angry, crying)*
What are any causes, triggers, or signs of onset?*
How is your child’s condition being managed? (e.g. therapy, medications)*
What techniques are most successful in supporting your child?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and / or their condition?*
Attention Deficit/Hyperactivity Disorder
HIDDEN - What specific condition does your child have?*
What ADHD symptoms does your child have?*
When was your child diagnosed?*
What impact does this condition have on your child’s day to day health?*
How easily is your child redirected? What strategies are most successful in working with your child?*
Does your child struggle with impulsivity? If yes, how does it manifest?*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and their condition?*
Emotional / Psychiatric Disorder or Concern
What specific condition does your child have?*
HIDDEN - What is your child's diagnosis?*
When was your child diagnosed?*
What are your child’s symptoms? (e.g. withdrawn, angry, crying)*
What are any causes, triggers, or signs of onset?*
How is your child’s condition being managed? (e.g. therapy, medications)*
How well does your child manage and communicate about their condition?*
What techniques are most successful in supporting your child?*
Is there anything else that we should know about your child and / or their condition?*
Substance Abuse (drugs, tobacco, alcohol)
What substance(s) does your child abuse?*
When was the substance abuse occurring? Is your child currently abusing?*
What is/ was the frequency of use?*
How is your child’s condition being managed? (e.g. therapy, medications)*
Do you have concerns about your child going through withdrawals on the expedition? If yes, what withdrawal symptoms might we see?*
Is there anything else that we should know about your child and/or their condition?*
Eating Disorder
What specific condition does your child have?*
When was your child diagnosed?*
Please describe your child’s eating disorder (e.g. restricting, binging, purging, overeating, hoarding, picky eater, sneaking)*
What are any causes, triggers, or signs of onset?*
How is your child’s condition being managed? (e.g. therapy, medications)*
What food accommodations would best support your child on the expedition? Please let us know if you would like to review the menu or provide food you know your child will like.*
How well does your child manage and communicate about their condition?*
Is there anything else that we should know about your child and their condition?*
If you would like to see a menu or are considering providing supplemental food/snacks please contact us at [email protected] to make arrangements.
Self-Harm Behaviors
How does your child-self harm?*
Is your child currently self-harming/time of last self-harm episode?*
What are any causes, triggers, or signs of onset?*
Is there anything else we should know about your child and their condition?*
Other Health Information
Does your child have any physical limitations relevant to their safety? (vision, hearing, balance, adaptive devices, etc.)*
- No
- Yes
If yes, please explain:*
Has your child had surgery or been hospitalized overnight (for any other reason than previously disclosed)?*
- No
- Yes
When was your child's surgery or hospitalization?*
What was the reason for your child's surgery or hospitalization?*
Has your child been cleared for all activity? Are there any lasting complications or considerations?*
Does your child have any special needs?*
- No
- Yes
If yes, please explain:*
Does your child have any specific dietary restrictions (ie. vegetarian)?*
- No
- Yes
If yes, please explain:*
Is there anything else you would like to tell us about your child?
Medications
“Medication” is any substance a person takes to maintain and/or improve their health.
- List ALL prescription & non-prescription medications your child is currently taking on a regular basis. Please also list prescribed medication for emergency situations (ie. inhaler, epinephrine).
- We expect that your child will bring two sets of their medications on expedition in case of damage to or loss of the medications while on program. Each set should be enough medication to last the entire expedition.
- A copy of the original pharmacy label(s) detailing the participant’s name, frequency, dosage, and how the medication should be given should accompany all medications.
- Please specify if the medication needs to be refrigerated (such as insulin) or requires specific storage requirements.
- If an inhaler or auto-injector is needed, the child needs to plan to have it easily accessible while on expedition.
Is your child allergic to any medications?*
- Yes
- No
If yes, please list*

Medication	Date Started	Dose	Frequency	Purpose	Side Effects	If Forgotten	How Delivered	Storage Requirements

By signing this form, I certify that I have completed the medication list accurately, and that I give my permission for a designated GCY representative to administer the medications listed above to the trip participant in the event of an emergency or where the participant requires reasonable assistance in self-administration of medications. I understand that GCY representatives will do their best to adhere to the medication schedule and dosage set forth above, but it is possible that dosages will be missed or delayed, or an incorrect dosage given due to circumstances over which GCY representatives have limited control, or as a result of an error by GCY representatives. I assume that risk on behalf of my child. I also understand by knowingly filling out the form inaccurately or by withholding pertinent information about the trip participant’s medications, I could increase the risk to the trip participant and others.
Parent/Legal Guardian Signature - Medication Permissions*
Physician Information
If GCY has safety concerns regarding the participation of your child, we may contact you to gather more information. If your child has a medical condition, GCY may require a medical release from their physician before they are allowed to participate on a GCY program.
Physician's Name
First Last
Physician's Phone
Insurance Information
Medical insurance is not required to participate. However, each participant and/or their parent(s)/guardian(s) are responsible for any and all expenses arising out of a participant’s medical emergency, including the cost of evacuation. We recommend contacting your insurance company to ensure coverage or purchasing trip insurance. Evacuations can be very costly.
Insurance Company
Policy Holder Name
First Last
Policy Number
Group Number
Insurance Company Phone
Medical Release
In the event of an injury or illness requiring medical care for the participant, I hereby give permission and consent to attending medical personnel, Grand Canyon Youth’s officers, directors, employees, representative agents, volunteers, contract individuals and all other persons or entities associated with it, to render any and all necessary treatment, including administration of epinephrine.
Parent/Legal Guardian Signature - Medical Release*

GCY COVID-19 Health Agreement

COVID-19 Health Agreement

Please read this agreement carefully. All GCY participants will be expected to agree to these requirements in order to be allowed on expedition.

The possibility of transmission and contraction of COVID-19 are inherent risks when in close proximity to other humans, and thus cannot be eliminated on Grand Canyon Youth (GCY) expeditions. However, these risks can be mitigated if all participants take their personal role in the ongoing health of themselves, other participants, and GCY staff seriously. All participants must accept and assume this risk.

The most effective way to reduce transmission while on GCY expeditions is to not bring it with us. Please read the following information about your role in reducing the risk of bringing COVID-19 on your expedition. These behaviors and expectations will be required of everyone on the expedition, including youth, adults, and staff.¹

If you are traveling with a group, your school/organization may have different requirements than those listed below. GCY will default to the most conservative mitigation measures as a requirement for your expedition. Please reach out if you have questions regarding what is expected of you before your expedition.

GCY may revise these requirements as recommendations evolve. You will receive a copy of the most current health agreement in the weeks prior to help you prepare. GCY encourages all eligible participants, volunteers, and staff to be vaccinated. In some cases a COVID-19 vaccine may be required to participate. If you have a compromised immune system we recommend talking with your healthcare provider to discuss the activities included in this expedition and possible extra precautions that may need to be taken to prevent COVID-19.

Reporting to Grand Canyon Youth

I will let GCY know if I have had moderate to severe COVID-19 (symptoms lasting more than 5 days or requiring hospitalization) since filling out my application. There are possible latent COVID-19 side-effects in children that may require physician clearance. Please email [email protected] with any relevant information.
In the 5 days leading up to my expedition I will check daily for signs and symptoms of COVID-19. If I have COVID-19 symptoms I understand I will not be permitted to go on my expedition for my health and the health of others. I will contact GCY to determine next steps.
Vaccinations

Not Vaccinated	Fully Vaccinated
I will provide proof of a negative COVID-19 test (PCR or Antigen tests only) taken within 5 days of the start of my expedition. GCY will not accept antibody tests.	I will provide proof of vaccination

*Anyone without proof of a negative test or vaccination record will not be allowed to participate.

Fully Vaccinated Individuals Pre-Trip Behavior

I will follow CDC recommended behavior for fully vaccinated persons . I will be extra cautious before my expedition for my safety and the safety of others.

Unvaccinated Individuals Pre-Trip Behavior

14 days prior to my expedition:

I will avoid large gatherings and crowded spaces that increase the risk of exposure to COVID-19.
I will adhere to CDC recommended social distancing guidelines. I will stay at least six feet from other people who are not from my household.
I will adhere to CDC recommended masking guidelines. I will wear a mask over my mouth and nose in public, and if around people not in my household.
I will adhere to CDC recommended personal health guidelines including: frequent hand washing, covering coughs/sneezes, and cleaning/sanitizing frequently-touched surfaces.
I will actively monitor my health for fever, cough, shortness of breath, or other symptoms of COVID-19.
I will report to GCY if, within the two weeks prior to my expedition, I develop symptoms of, test positive for, and/or am exposed to someone who tests positive for COVID-19.

Pre-Trip Screening

Prior to departure, GCY will conduct a health screen for symptoms of COVID-19, this may include an additional COVID-19 test.

I understand that if I fail to meet the requirements of the pre-screening, I will not be permitted to participate.

GCY accepts and understands that some people may continue to test positive after they are no longer contagious. There is no way to test for contagiousness:

I understand that any person with a positive test result will not be permitted to participate.

On-Trip Behavior

While participating on my GCY expedition, I will follow GCY’s COVID-19 mitigation measures, such as masking, distancing, handwashing, etc.
If I experience any signs or symptoms of COVID-19, I will do my best to distance myself from the group and communicate with a Trip Coordinator and/or GCY Field Staff.

¹ To the extent any participant cannot comply with the requirements as set forth in this agreement, GCY will make reasonable accommodations for the participant, so long as such reasonable accommodations can be made without being a direct threat to the health and safety of other participants or GCY employees or stakeholders.

Vaccination Records
GCY requires COVID-19 vaccination/testing records from all participants (GCY Field Staff and adult chaperones included). Please let us know your status or plan for getting vaccinated before your expedition:*
- I am fully vaccinated and have uploaded my vaccination records below.
- I plan to be fully vaccinated before my expedition and will provide proof of vaccination records to GCY.
- I plan to provide proof of a negative COVID-19 test result.
- I am not sure yet
Participant COVID-19 Vaccination Record
Drop files here or

Accepted file types: jpg, png, pdf.
COVID-19 Medical History
Have you had a moderate to severe case of COVID-19 (symptoms lasting more than 10 days, hospitalized, experiencing 'Long COVID')? This is important due to possible latent side-effects of COVID-19.*
- Yes
- No
BY SIGNING BELOW I AGREE TO THE ABOVE, OUTLINED EXPECTATIONS.
Parent/Legal Guardian Signature - Health Agreement*
Legal Guardian Full Name*
Date*
MM
DD
YYYY
Participant Signature - Health Agreement*
Participant Full Name*
Date*
MM
DD
YYYY

AGREEMENT TO ASSUME ALL RISKS; RELEASE OF LIABILITY/ AGREEMENT NOT TO SUE & TO INDEMNIFY
Please read this contract carefully. It releases Grand Canyon Youth from liability and waives certain rights.

In consideration of being permitted to participate in an adventure trip with Grand Canyon Youth, Inc., an Arizona nonprofit corporation (“GCY”), I, the Participant (or, if the Participant is under the age of 18, I on the Participant’s behalf), understand, acknowledge, and contractually agree as set forth below (the “Agreement”):

1. Acknowledgement of Dangers and Risks:
I understand, acknowledge, and agree that participating in outdoor pursuits including rafting and camping on a river trip and transport by GCY to and from these activities (hereinafter the “Activity”) can be HAZARDOUS AND INVOLVE THE RISK OF PHYSICAL INJURY AND/OR DEATH. I understand, acknowledge, and agree that participating in the Activity involves certain inherent dangers and risks that cannot be eliminated or controlled by GCY, the presence of which are integral to the recreational and adventurous nature of the Activity. The following list of dangers and risks that could cause physical or emotional injury or death is not exhaustive, and I understand that there are many other dangers or risks associated with the Activity not listed below: 1) Risks associated with boating and being around or in water, including: capsizing or sinking watercraft; falling into water; water immersion; drowning; hypothermia; rapid changes in water flow, level, or speed; jolting or jarring resulting in contact with hard objects such as boats, oars, oarlocks, other participants, containers, coolers, or other equipment, supplies, or objects; becoming tangled in ropes; foot entrapment; trapped limbs; jumping, diving, or being washed or thrown into unfamiliar water with submerged hazards; striking objects under the surface of the water; being pinned against trees, tree strainers, rocks, roots, or other submerged objects; boat equipment malfunction; slipping, tripping, or falling in, around, or from boats; and slipping, tripping, or falling while walking, paddling, or wading in rough terrain or along rivers edge; and errors in guide judgment, or lapse in guide skill. 2) Risks associated with transport in a motor vehicle, including: all commonly understood risks of riding in a vehicle; being struck or other injurious contact with vehicles; injurious contact with equipment being unloaded from vehicles; risks associated with riding in a vehicle in remote terrain on backcountry or four-wheel-drive roads; and lapse in driver judgment or skill. 3) Risks associated with being on an outdoors trip with other participants and relying upon guides, including: mentally or physically unstable or criminal trip participants; dangerous actions, negligence, intentional misconduct, or malice by other participants; dangerous actions taken by other participants as a result of consumption of alcohol or drugs; and errors in guide judgment or lapse in guide skill. 4) Risks associated with camping, recreational activities, and exposure to the elements on a river trip, including: slipping, tripping, or falling; flying man-made objects such as balls, frisbees, gear, or equipment; falling trees or other objects; being struck with or injured by a tool while performing service projects; injury associated with removing vegetation or picking up trash on service projects; moving objects associated with extreme weather and wind; extreme weather; temperature fluctuations; wind; hail; storms and lightning; landslides; rock-fall; mudslides; avalanche; water crossings; flash flood; low light or darkness; wildfire; uncontrolled camp or kitchen fire; kitchen- or cooking-related dangers; choking; food-borne bacteria or virus; water-borne bacteria or virus; frostbite and hypothermia; mental or physical shock; burns or burning associated with campfires, hot surfaces, and sun exposure; all manner of injuries including brain injury, spinal injury, paralysis, fractures, punctures, burns, strains, sprains, lacerations, internal injury, sickness or disease, exposure to airborne pathogens and viruses, including but not limited to contraction of COVID-19; heat exhaustion, heatstroke, dehydration, hyponatremia, asphyxiation, and high-altitude sickness; snake bites; insect bites; scorpion stings, bee stings; allergic reaction to insects or plants such as poison ivy; allergen exposure; exposure to or attack by wildlife or domesticated animals; bodily failure while carrying heavy objects; overexertion; fatigue; dizziness or disorientation; diminished reaction time; getting lost; inadequate or incorrect medical care; lack of readily accessible medical resources or care; poorly executed or failed rescue attempts; failure or lack of communication equipment or cell phone service; dangerous contact with rescue vehicles, boats, or aircraft; inadequate or malfunctioning equipment; & mental, physical, or emotional injury or distress from exposure to any of the above. I understand that GCY has done its best to list the known risks of participating in the Activity, but agree that I have the right, obligation, and opportunity to research and verify the risks of participating in the Activity.

2. Assumption of Risk:
I acknowledge and agree that I am choosing to take part in the Activity despite the dangers and risks of doing so, and I freely choose to accept the risks of participating in the Activity. I recognize that property loss, physical or emotional injury, and death are all possible while participating in the Activity. I expressly acknowledge and assume all risks, dangers, and consequences of the Activity, including but not limited to those risks, dangers, and consequences set forth in paragraph 1, above, that may result in physical or emotional injury, property damage, or death.

3. Participant’s Responsibilities and Representations:
I represent that I am physically and mentally capable of participating in the Activity. I understand the importance of all safety instructions given to me, whether in writing or verbally, and agree to follow all staff instructions at all times while engaging in the Activity. Further, I represent that I have had the opportunity to both independently research and discuss with GCY the risks of participating in the Activity and my assumption of those risks. I have been informed of and understand the expectations of me while engaging in the Activity. I have been informed of the increased risk associated with running whitewater and of the changing nature of such risk as water levels change. I understand that I am responsible for truthfully disclosing and notifying GCY of any risk to me or other participants associated with my own mental or physical conditions, including allergies that could result in anaphylaxis or other adverse physical reactions. I specifically and expressly agree that I have full responsibility for managing and treating any such conditions to prevent injury to myself or others. I am not relying on any prior oral, written, or visual representations made by GCY, including in any website or promotional materials, to induce me to go on any adventure activity. With all of the foregoing in mind, I assume full responsibility for my own safety.

4. Release of Liability and Agreement Not to Sue:
Fully understanding the foregoing paragraphs, and in exchange for GCY’s agreement to allow the Participant to participate in the Activity, I HEREBY AGREE NOT TO SUE GCY, its affiliated companies and subsidiaries, or any of their respective successors in interest, affiliated organizations and companies, insurance carriers, agents, contractors, employees, representatives, assignees, officers, directors, and (each hereinafter a “Released Party”) for any damage (including but not limited to equipment damage), injury, or loss to Participant, including death, that Participant may suffer arising in whole or in part out of Participant’s participation in the Activity. By signing this Agreement Not to Sue, I am releasing any right to make a claim or file a lawsuit against any Released Party. I agree to hold harmless and release each and every Released Party from any and all liability and/or claims or causes of action for injury or death to persons or damage to property arising from Participant’s participation in the Activity, INCLUDING, BUT NOT LIMITED TO THOSE CLAIMS BASED ON ANY RELEASED PARTY’S ALLEGED OR ACTUAL NEGLIGENCE or breach of any contract and/or express or implied warranty.

5. Agreement to Indemnify:
I agree to INDEMNIFY (REIMBURSE) each Released Party from and for any and all claims of the Undersigned and/or a third party arising in whole or in part from Participant’s participation in the Activity. In other words, if Participant and/or anyone on Participant’s behalf files any lawsuit or brings any claim for injury or damage against any Released Party, undersigned will be required to pay back to any and all Released Party all sums of money incurred by, or paid by or on behalf of, any Released Party on account of the bringing of such suit or claim, including all attorney’s fees and costs.

6. Medical Authorization, Release, and Indemnification:
I hereby 1) authorize GCY to undertake any emergency medical care for Participant; 2) authorize any Released Party and/or their authorized personnel to call for medical care for the Participant or to transport the Participant to a medical facility or hospital if, in the opinion of such personnel, medical attention is needed; 3) agree that, following Participant’s transport to any such medical facility or hospital, the Released Party shall not have any further responsibility for Participant; 4) agree to pay all costs associated with the medical care and related transportation provided for the Participant; and 5) shall indemnify and hold harmless (as set forth in paragraph 5, above) any Released Party from any and all liability and/or claims associated with such medical care and/or related transportation.

7. Application of Agreement to Minor Participants:
In the case of a minor Participant, I, as parent or legal guardian, acknowledge that I am signing this Agreement on behalf of the minor Participant, and that the minor shall be bound by all of the terms of this Agreement. Additionally, by signing this Agreement as the parent or legal guardian of a minor Participant, I understand that I am also waiving certain rights on behalf of the minor that the minor otherwise may have. I agree that but for the foregoing, the minor Participant would not be permitted to participate in the Activity, and I sign this document out of a desire to have the Participant be allowed to participate in the activity. I represent that I am a legal parent or guardian of the minor Participant.

8. Representation of Capacity to Contract, and Acknowledgement That Agreement is a Binding Contract:
I represent that I am at least 18 years of age, and that I have the capacity to understand and be bound by all of the provisions of this Agreement. I understand and acknowledge that this Agreement is a contract and shall be binding to the fullest extent permitted by law. It is my intent that this Agreement shall be binding upon my assignees, subrogors, distributors, heirs, next of kin, executors, and personal representatives, and those of the Participant.

9. Agreement to Application of Arizona Law and Selection of Forum:
I agree that any and all claims for injury and/or death arising from my participation in the Activity shall be governed by Arizona law, and that the exclusive jurisdiction for any claim shall be in the Coconino County, Arizona District Court, without regard to where the incident giving rise to any lawsuit occurs, and without regard to any jurisdiction’s choice of laws analysis. I agree that GCY is not a common carrier.

10. Miscellaneous Provisions:
If any sentence, clause, paragraph, or part of this Agreement is declared unenforceable, the remainder shall continue in full force and effect. This Agreement can be modified only in writing. An electronic signature or acknowledgment upon this Agreement is fully binding and enforceable, and a copy of this executed Agreement may be used as if it is the original. I agree that any subcontractors or other vendors utilized by GCY during or incidental to the Activity are solely responsible for injury that occurs to me while I am in their care, and that GCY is not in a joint venture with any such vendor.

I HAVE CAREFULLY READ THE FOREGOING AGREEMENT AND UNDERSTAND ITS CONTENTS. I AM AWARE THAT I AM RELEASING CERTAIN LEGAL RIGHTS THAT I OR MY MINOR CHILD MAY OTHERWISE HAVE. I AGREE TO BE FULLY BOUND BY THE TERMS OF THIS AGREEMENT.
Parent/Legal Guardian Signature - Assumption of Risk*
Legal Guardian Full Name*
Date*
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Participant Signature - Assumption of Risk*
Participant Full Name*
Date*
MM
DD
YYYY

Parent / Guardian Permission for Participation
There are inherent risks involved with participating in the GCY expedition. It is a parent’s/guardian’s responsibility to become informed about these risks and make a deliberate choice in supporting your child’s participation. Many of the known risks are listed in the liability waiver that is a part of this application, but parents/guardians have the affirmative and final obligation to become informed about GCY programs prior to allowing their child to participate.
- We rely on parents’/guardians’ judgment to not involve their child in our expeditions if they believe the child could pose a behavioral risk to themselves or others. Knowing disregard of this potential risk may result in parent/guardian liability.
- GCY is a private, nonprofit organization. We have the right to exclude any participant who we believe, at our sole discretion and for any reason, could pose a risk to themselves or other participants beyond our ability and resources to manage within an appropriate standard of care. All participants must meet GCY’s “Essential Eligibility Criteria.” Parents/guardians must review this document and hereby certify that their child meets the stated criteria.
- If Trip Leaders and/or Trip Coordinators have cause to believe any participant is unwilling to follow directions, safety rules, the law, or represents an unacceptable risk to themselves or to others, that participant may be separated from the group and evacuated from the trip at the expense of parents/guardians. Participant may be held legally responsible if they break any law while participating in the GCY program.
- Parents/Guardians hereby agree to talk with their child about the requirements of participation in a GCY program, stressing the importance of following all expectations and safety practices set by GCY.
- Parents/Guardians should encourage their child to communicate any concerns immediately with adult supervisors on the trip.
I have read and acknowledge the information and requirements in this form and consent to my child’s participation in a GCY program knowing of all above risks. My child fully understands, and they will adhere to all expectations outlined in the personal contract. My child may also participate in all activities pertaining to GCY, including fundraisers, community service projects, transportation, and river trips during their involvement. Breach of this contract may lead to participant’s dismissal from the program.
Parent/Legal Guardian Signature - Parent/Guardian Permission for Participation*
Cancellation & Refund Policy
Grand Canyon Youth reserves the right to cancel any expedition and/or alter expedition dates due to weather, safety concerns, and/or any other unforeseeable circumstances. If GCY cancels your expedition, all payments will be refunded. If a participant cancels more than 45 days before the departure day, expedition payments will be refunded, less a 10% non-refundable deposit of the total expedition price. All other cancellations are ineligible for a refund. *If you are participating through a school/organization, your school/organization may have an overriding cancellation or refund policy.
Parent / Legal Guardian Initials*
Media Release
I hereby grant Grand Canyon Youth, its co-sponsoring organizations, partners, media representatives, employees, volunteers, and trip participants the right to photograph, record, or film my child’s participation in a Grand Canyon Youth program without recompense. This includes the right to use photographs, audio, or film in promotional, documentary, online, print, digital, and media outlets.
Media Release*
- Yes
- No
Parent / Legal Guardian Initials*
Certification of Information Provided
To the best of my knowledge and belief, all the information set forth within this application is complete, true, and correct. I understand that all the entities participating in the GCY program will rely on the information contained herein to make a decision as to whether or not this participant may safely complete the activities required to participate in the GCY program. Participants younger than 18 years must have a parent or legal guardian signature. Grand Canyon Youth reserves the right, in its absolute discretion, to terminate this program or anyone’s participation in the program, at any time, for any reason, including but not limited to any participant’s failure to comply with any application requirements or GCY's directives. I have read this application in its entirety and fully understand and agree to the terms and information within.
Parent/Legal Guardian Signature - Certification of Information Provided*

Are you interested in applying for financial aid?*
- Yes
- No
Financial Aid
Grand Canyon Youth, along with our donors, is proud to offer financial aid to youth in need. We do not want expedition price to be a barrier to your participation. Fill out this form together with your youth, and plan how you can reach your fundraising goals. Funds are limited, and GCY works to distribute financial aid equitably. Please ask for what you need.

Request Process
1. Fill out this form completely. Your financial aid award is based on your financial information and short answer responses. Be thoughtful, honest, and thorough.
2. GCY will process your request and email you your financial aid award.
3. After your trip, write a thank you letter and mail it to Grand Canyon Youth. Please share a story of your experience. Failure to write a thank you may prohibit you from receiving financial aid in the future.
Parent & Youth Collaborative Questions
Think about how you and your youth can pay for this expedition. Consider family contributions, GCY financial aid, and fundraising opportunities. Fill in each line with the amount you are able to contribute, even if the answer is $0. All of your responses should add up to the total price of your GCY expedition.
HIDDEN- $50 Deposit*
Amount parents/guardians will contribute*
Amount participant will fundraise/earn*
Amount of financial aid you are requesting*
TOTAL*
Parent/Legal Guardian Questions
What is your estimated Household Gross Annual Income?*
How many adults contribute to this income?*
Total number in household*
Has your youth participated in a Grand Canyon Youth Program in the past?*
- Yes
- No
If yes, did you receive financial aid?*
- Yes
- No
Does your family qualify for free & reduced lunch?*
- Yes
- No
Please tell us about any extenuating or compelling circumstances that demonstrate your financial need.*
Youth Questions
Answer the following questions to the best of your ability. *All questions have a 100-word minimum*
What are your most treasured skills or talents? How do you share those with others and how would they help you on this GCY program?*
Why is this expedition important to you? Provide 2-3 reasons.*
I hereby certify that all provided information is accurate and complete. Please consider us for financial assistance. I am requesting only what we need and I understand that funds are limited.
Parent/Legal Guardian Signature*
Participant Signature*
Email
This field is for validation purposes and should be left unchanged.

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Contact Us

About Us

In service to our mission and values, GCY would like to acknowledge that we are located on, and visit, the ancestral homelands of the Diné (Navajo), Havasu Baaja (Havasupai), Hoputuh Shi-ni-mu (Hopi), Kvav-Kapai (Hualapai), Nde (Apache Western/Yavapai), Nuciu (Ute), and Numa (Paiute) Peoples, past and present. We recognize with gratitude the people who have stewarded these lands since time immemorial and the vibrant Native communities who make their home here today.

Grand Canyon Youth is a 501(c)(3) nonprofit organization

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Youth Application

Hidden Fields

**Travel Requirement**

Participant Information

Parent/Legal Guardian 1

Parent/Legal Guardian 2

Alternate Emergency Contact

Participant Health Information

Medical History

Heart Condition

Diabetes / Hypoglycemia

High or Low Blood Pressure

Migraines / Severe Headaches

Seizures / Epilepsy / or other Neurological Disorder

Serious Head Injury

Urological Condition/ Reoccurring UTI

Anemia / Blood Disorder

Musculoskeletal Disorder/Arthritis

Anaphylaxis / Severe Allergic Reaction

Asthma / Respiratory Condition

Gastrointestinal Condition

Food Allergy / Intolerance (Non-Anaphylactic)

Pregnancy

Sleep Disorder / Sleepwalking / Night Terrors

Developmental Disability or Delay

Depression / Anxiety

Attention Deficit/Hyperactivity Disorder

Emotional / Psychiatric Disorder or Concern

Substance Abuse (drugs, tobacco, alcohol)

Eating Disorder

Self-Harm Behaviors

Other Health Information

Medications

Physician Information

Insurance Information

Medical Release

GCY COVID-19 Health Agreement

COVID-19 Health Agreement

Reporting to Grand Canyon Youth

Fully Vaccinated Individuals Pre-Trip Behavior

Unvaccinated Individuals Pre-Trip Behavior

14 days prior to my expedition:

Pre-Trip Screening

On-Trip Behavior

Vaccination Records

COVID-19 Medical History

BY SIGNING BELOW I AGREE TO THE ABOVE, OUTLINED EXPECTATIONS.

AGREEMENT TO ASSUME ALL RISKS; RELEASE OF LIABILITY/ AGREEMENT NOT TO SUE & TO INDEMNIFY

1. Acknowledgement of Dangers and Risks:

2. Assumption of Risk:

3. Participant’s Responsibilities and Representations:

4. Release of Liability and Agreement Not to Sue:

5. Agreement to Indemnify:

6. Medical Authorization, Release, and Indemnification:

7. Application of Agreement to Minor Participants:

8. Representation of Capacity to Contract, and Acknowledgement That Agreement is a Binding Contract:

9. Agreement to Application of Arizona Law and Selection of Forum:

10. Miscellaneous Provisions:

I HAVE CAREFULLY READ THE FOREGOING AGREEMENT AND UNDERSTAND ITS CONTENTS. I AM AWARE THAT I AM RELEASING CERTAIN LEGAL RIGHTS THAT I OR MY MINOR CHILD MAY OTHERWISE HAVE. I AGREE TO BE FULLY BOUND BY THE TERMS OF THIS AGREEMENT.

Parent / Guardian Permission for Participation

Cancellation & Refund Policy

Media Release

Certification of Information Provided

Financial Aid

Request Process

Parent & Youth Collaborative Questions

Parent/Legal Guardian Questions

Youth Questions

Travel Requirement