School of the Wild Winter Workshop: Winter Birds
This form must be filled out before your child may attend one of our workshops. A separate form is required for each child. Thank you. *Filling out this form does not guarantee enrollment. 
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Child's Name *
Child's Date of Birth *
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DD
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Parent/Guardian Name *
Phone Number *
Parent/Guardian Email *
Emergency Contact (other than parent/guardian filling out application) *
Emergency Contact Phone Number *
Name of Child's Physician *
Physician Phone *
Student Allergies/Medical Conditions: Please list any allergies (food or environmental) or medical conditions your child has. If none, write 'none.' * *
Medication: Does your child regularly take any prescribed medication or carry an epipen? If so, please list and describe below. If not, please write 'none.' *
Schedule, Tuition, and Payment
Tuition is non-refundable and payment is due when stated on the invoice. By enrolling in our classes, families assume responsibility for the full balance due, regardless of the days their child actually attends. No refunds or credits will be given for classes missed, including those due to travel, illness, or schedule conflicts. Makeup classes may be offered if School of the Wild cancels classes due to severe weather or another unforeseen circumstance.

Schedule, Tuition, and Payment *
I have read, understand, and agree to the terms of 'Schedule, Tuition, and Payment' above.
Required
Consent for Medical Treatment
In the case of a medical emergency, I understand that every reasonable attempt will be made to contact the parent(s)/guardian(s) or another designated emergency contact. However, in the event that I cannot be reached, I give my permission to the Leaders of School of the Wild to help my Child and secure emergency medical treatment. I agree to pay for any charges for emergency medical treatment that are not covered by my personal health insurance. This acknowledgement and consent applies for the duration of time that my child attends class.
Consent for Medical Treatment *
I have read, understand, and agree to the terms of the 'Consent for Medical Treatment' above.
Required
Acknowledgment of Risk: Please read.
I acknowledge that there are risks inherent in any youth activity, including – but not limited to – injury arising from participation in outdoor physical activity. I acknowledge that all risks cannot be prevented, and assume those beyond the reasonable control of the teachers and staff. In consideration of being permitted to participate in School of the Wild, on behalf of myself, my family, my heirs, and my assigns, I hereby release and hold harmless School of the Wild, its teachers and its staff from any liability for injury, loss, or death to the Child. In order to minimize risks to my Child and others, I will take responsibility to make sure that my Child is prepared for all activities, dressed appropriately for the weather, and is in good health for each class. I am also aware that the nature area has rough terrain, water, and wild animals. I appreciate and accept that risk and waive any right to pursue legal remedies associated with inherent risks of the park.
Acknowledgment of Risk *
I have read, understand, and agree to the terms of the 'Acknowledgement of Risk' above.
Required
Media Release *
I hereby consent and agree that School of the Wild has the right to take photographs and video clips of my child and to use these on their educational website and promotional materials without compensation. I understand my child's name and identity will not be revealed.
Required
Parent Signature *
By signing this form electronically, I attest I am the parent/guardian of the above child and I am the person whose name appears in the box below. I understand and agree to the terms stated and checked on this form. Please type your full name below.
Today's Date *
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