Family & Guardian Application

FAMILY & GUARDIAN APPLICATION

Thank you for your interest in participating with Eagle Mount!

This application is intended for family members and guardians of eligible Eagle Mount participants. As a family member or guardian of a person with a disability or a young person with cancer who engages with Eagle Mount, you are also eligible to engage in some Eagle Mount programs.

The following form must be filled out for EACH family member or guardian planning to engage with Eagle Mount.

If the applicant is under 18 years old, a parent or guardian shall fill out this application.

There are 2 steps to be completed:
1. Fill out the following form so that Eagle Mount can establish contact and acquire emergency information.
2. Complete required waivers.
Depending on programs selected, you may have to fill out supplemental applications pertaining to those individual programs.

Definitions:

"Participant" refers to a person that engages with Eagle Mount who has a disability or cancer diagnoses.

"Applicant" refers to the family member or guardian that this application is being filled out for.

"Family Members" are immediate family members including parents, children, siblings and spouses.

"Guardians" are legal guardians.

DO NOT refresh the browser window or use the browser back button while completing the form or your progress may be lost.
Are you a parent or guardian filing this form on behalf of someone else?*

YesNo
How did you learn about Eagle Mount?
Family members and guardians are eligible for the following programming at Eagle Mount:
- Select Oncology Camps (Big Sky Kids)
- Family Swim at our aquatics center
- Family Engagement which includes but is not limited to:
  - Family hikes
  - Family snowsports days
  - Family horsemanship days
  - Mom's days, dad's days, and sibling days.
    
    Skeet shooting
    
    Axe throwing
    
    Art nights
    
    etc.
  - Family recreation days
    
    Whitewater rafting
    
    Climbing
    
    Ziplining
    
    etc.
Check all programs the applicant is interested in*

Family EngagementFamily SwimOncology Camps (Big Sky Kids)

Applicant Information
Legal First Name*
Last Name*
Prefer to be Called
We love putting 'a face to the name.' If you can, please upload a photo! This photo will only be used in our internal database so Eagle Mount employees know who you are.
Date Of Birth*

Month (MM)Day (DD)Year (YYYY)
Gender

MaleFemalePrefer to self-definePrefer to not disclose
How does the applicant identify?*
Applicant's Mailing Address*
Applicant's Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Applicant's email*
Please double check! Our initial contact is via email!
Applicant's Phone Number*
Preferred Contact Method*

Phone (at phone number provided above)Email (at email provided above)Text (at phone number provided above)

Parent/Guardian information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian relationship*

ParentSpouseSignificant otherSiblingExtended familyFriendOther
Parent/Guardian Phone*
Parent/Guardian email*
Please double check! Our initial contact is via email!

Billing Information

Our programs have a wide range of available options to pay, and we offer scholarships for most programs to those that qualify. Please enter details for where we can send an invoice if and when necessary.
Payment party*

First NameLast Name
Billing Address*
Billing Address

Street Address

Street Address Line 2

CityState

Zip Code

Applicant Information

Applicant Eligibility Information

Parent/Guardian information

EMERGENCY CONTACT INFORMATION

Billing Information

Health Precautions