Fort Charlotte Camping Permit Application

Fort Charlotte Permit

Fort Charlotte is two remote backcountry campsites on the Pigeon River. It is the destination for paddlers coming from the Boundary Waters Canoe Area Wilderness or points beyond to the west or north. These campsites also offer a welcome place to spend the night for hikers wanting to split the 17 mile Grand Portage hike into two days – the only place within Grand Portage National Monument where camping is allowed.

Need help with the application?

Please call 218-475-0123 or email us
 

Instructions for filling out the form:

Make sure to include your name, email address, and preferred dates you plan to camp or we cannot process your application.

Complete the following fields:

• Applicant Information: be sure to include a valid email address
• Additional Contact Information: phone numbers to contact you
• Emergency Contact Information: someone to contact who is NOT camping with you
• Mode of Transportation:
  • VEHICLE: Will you be leaving a vehicle? Model, license plate, parking location (Heritage Center or Old Highway 61).
  • WATERCRAFT: Canoeing from the Boundary Waters? What type of craft? (fill out form details)
• Itinerary Details: requested dates for camping nights at Fort Charlotte – 1^st, 2^nd, 3^rd choices

NPS Form 10-404 (Rev. 08/2017)
National Park Service

OMB Control No. 1024-0022
Expiration Date 01/31/2024

Applicant Information

Last Name

First Name

Middle Initial

Suffix

Street Address

City

State

Zipcode

Country

Email Address

Next Step

Additional Contact Information

Home Phone #

Cell Phone #

Work Phone #

Fax #

For the purposes of improving your visit, the National Park Service may seek to understand more about your visitor experience on this Wilderness/Backcountry trip. Are you willing to allow your contact information be used to follow up on social science information needs by the NPS in the future?

Yes

Next Step

Emergency Contact Information

Point of Contact Name

Relationship

Family

Friend

Point of Contact Phone Number

Point of Contact City/State

Next Step

Mode of Transportation

Vehicle

License Plate State

License Plate Number

Vehicle Make

Vehicle Model

Vehicle Color

Is the vehicle a rental?

 Yes

Location where the vehicle will be parked

Aircraft

Registration State

N-Number

Aircraft Make

Aircraft Model

Aircraft Color

Is the aircraft a rental?

 Yes

Watercraft

Registration State

Hull Registration Number

Watercraft Type

Watercraft Make

Watercraft Model

Size (feet)

Watercraft Color

Is the watercraft a rental?

 Yes

Watercraft Launch Site

Watercraft Take Out Location

Watercraft Launch Date in MM/DD/YY format

Watercraft Take Out Date in MM/DD/YY format

Watercraft Trailer Parking Location

Snowmobile

Registration State

Plate Number

Snowmobile Make

Snowmobile Model

Snowmobile Color

Is the snowmobile a rental?

 Yes

Snowmobile Parking Location

Off-Road Vehicle (ORV)

Registration State

Plate Number

Off-Road Vehicle Make

Off-Road Vehicle Model

Off-Road Vehicle Color

Is the Off-Road Vehicle a rental?

 Yes

Off-Road Vehicle Parking Location

Next Step

Itinerary Details

Start Date - MM/DD/YY

End Date - MM/DD/YY

Entry Location

Exit Location

Night 1 Date - MM/DD/YY

Night 1 Campground/Trail Name

Night 2 Date - MM/DD/YY

Night 2 Campground/Trail Name

Night 3 Date - MM/DD/YY

Night 3 Campground/Trail Name

Night 4 Date - MM/DD/YY

Night 4 Campground/Trail Name

Night 5 Date - MM/DD/YY

Night 5 Campground/Trail Name

Night 6 Date - MM/DD/YY

Night 6 Campground/Trail Name

Night 7 Date - MM/DD/YY

Night 7 Campground/Trail Name

Number of Campsites

Number of Nights

Group Size

Minimum Group Size

Flexible Itinerary

Similar/Nearby Campsites

Reversed Itinerary

Alternate Dates

Alternate Start Date - MM/DD/YY

Alternate End Date - MM/DD/YY

Earliest Start Date - MM/DD/YY

Latest End Date - MM/DD/YY

Submit Form

Privacy Act Statement

General: This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 21, 1984, for individuals completing this form.

Authority: 54 U.S.C. §100101, NPS Organic Act; 16 U.S.C. 1131-1136, Wilderness Act; 43 U.S.C. §1701 et seq., the Federal Land Policy and Management Act; 54 U.S.C. §200301-200310, Land and Water Conservation Fund Act, as amended; 16 U.S.C. §6801-6814, the Federal Lands Recreation Enhancement Act; 36 CFR Part 71, Recreation Fees; and, 36 CFR 1.6, Permits.

Purpose and Uses: To establish and verify an applicant's eligibility for a permit to conduct certain activities within the National Park System and to process permits for individual members of the public and organizations interested in obtaining a permit authorizing an activity. Information collected will be used to provide the public and permittees with permit-related information, to monitor activities conducted under a permit, to analyze data and produce reports to monitor the use park resources, to assess the impact of permitted activities on the conservation and management of protected species and their habitats, and to evaluate the effectiveness of the permit programs. The DOI and NPS may use the information to meet reporting requirements, to generate budget estimates and track performance, and to assist park staff with visitors’ education, fee collection, resource management and protection, recreational use planning, law enforcement and public safety personnel for such purposes as emergency contact and search and rescue efforts; to provide permit holders and participants with information about parks and their partners; and to provide reports of activities conducted under an issued permit.

Based on the disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, the National Park Service may share information with first responders and Federal, state, and local governments to provide information needed to locate an individual or render aid in an emergency; to recover debts owed to the United States; to respond to a violation or potential violation of the law; in response to a court order and/or discovery purposes related to litigation; or other authorized routine use when the disclosure is compatible with the purpose for which the records were compiled.

Effects of Nondisclosure: It is in your best interest to answer all of the questions. The U.S. Criminal Code, Title 18 U.S.C. 1001, provides that knowingly falsifying or concealing a material fact is a felony that may result in fines of up to $10,000 or 5 years in prison, or both. Deliberately and materially making false or fraudulent statements on this form will be grounds for not granting you a Backcountry/Wilderness Use Permit.

Information Regarding Disclosure of Your Social Security Number Under Public Law 93-579 Section 7(b): Your Social Security Number is not needed to complete this form.

Paperwork Reduction Act Statement

We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) and 36 CFR 1-7, 12 and 13 which authorize the National Park Service to require applicants to fill out this form to monitor resources and to protect visitors. This information is being collected to allow the park management to make value judgements necessary to enhance the safety and enjoyment of both the visitors and wildlife. All applicable parts of the form must be completed in order for your request to be considered. You are not required to respond to this or any other Federal agency-sponsored information collection unless it displays a currently valid OMB control number.

Estimated Burden Statement

Public Reporting burden for this form is estimated to average 8 minutes per response, including the time it takes for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Comments regarding this burden estimate or any aspect of this form should be sent to the Information Collection Clearance Officer, National Park Service, 12201 Sunrise Valley Dr. (MS-242), Reston, VA 20192.