DH Ranch 2026 Program Registration Form
Classroom in the Dirt
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Program Selection *
Required
Child’s name: *
Birth Date *
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DD
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Child’s Status Number *
Nation or Community (optional) *
Parent or Guardian Full Name *
Phone Number *
Email Address *
Elder referral name and phone number:  An Elder referral letter is required to support this application. A referral letter template will be provided by DH Ranch. *
Medical Information (Allergies & Medication) Additional information to help support your child: *
DH Ranch occasionally takes photographs or video recordings during programs for educational, promotional, and reporting purposes, including Jordan’s Principle reporting, social media, website content, and printed materials.Jordan’s Principle ConsentI confirm that my child is a First Nations child and is eligible for supports through Jordan’s Principle.I give consent for DH Ranch to collect, use, and share the information provided in this form for the purposes of program registration, service delivery, safety planning, and Jordan’s Principle funding requirements.I understand that information may be shared only with Jordan’s Principle service coordinators, health or education professionals, and relevant funding administrators as required to support my child’s participation. *
Required
Jordan’s Principle ConsentI confirm that my child is a First Nations child and is eligible for supports through Jordan’s Principle.I give consent for DH Ranch to collect, use, and share the information provided in this form for the purposes of program registration, service delivery, safety planning, and Jordan’s Principle funding requirements.I understand that information may be shared only with Jordan’s Principle service coordinators, health or education professionals, and relevant funding administrators as required to support my child’s participation. *
Required
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