Hiking the Hood Registration Form
Please fill out the registration form below. Given the fact that we'll be out in the woods taking in nature in all of its glory, health insurance information is extremely important in the event of an emergency.

When you're done, please mail a check, made out to Corbett School District, in the amount of $150 with "Hiking the Hood Enrichment" in the memo line to:

Corbett School District
ATTN: Debbie Schneider
35800 East Historic Columbia River Highway
Corbett, Oregon 97019

What is your child's name?
Your answer
Child's birthday
Your answer
Got another child you're signing up? What's their name?
Your answer
That other child's birthday
Your answer
Parent's/Guardian's #1 Name
Your answer
Parent's/Guardian's #1 Primary Phone Numbers (work, home, mobile)
Your answer
Parent/Guardian's #2 Name
Your answer
Parent's/Guardian's #2 Primary Phone Numbers (work, home, mobile)
Your answer
Emergency Contact Name
Your answer
Emergency Contact's Phone Numbers (any and all)
Your answer
Does your child have any allergies or medical conditions that would potentially affect their participation in this program? (Excessive whining does not qualify). Keep in mind, we'll be hiking. In the woods. A lot. If so, please thoroughly explain.
Your answer
If your child will need to take any medication during the day, please list medication and times they will need to be administered.
Your answer
Health Insurance Carrier
Your answer
Primary Subscriber's Name
Your answer
Group Number
Your answer
ID Number
Your answer
Other than the parents/guardians and the emergency contact person, who else has your permission to pick up your child?
Your answer
READ THIS: By signing this permission slip, I hereby give my child(ren) permission to attend Corbett Summer Enrichment's Hiking in the Hood! enrichment program to be held from Monday, August 7 to Thursday, August 10, 2017. I understand the inherent risks of hiking outside and I understand that my child(ren)'s participation in this program depends on their ability to cooperate respectfully, and that not doing so could result in an expulsion from the program without a refund; I understand that my child(ren) will be transported in an official Corbett School District passenger vehicle or bus; I understand that I, or the other individuals listed above, am/are responsible for dropping off my child(ren) at 7:50 AM at Corbett Grade School during each day of the program and picking them up at the designated time each day. SIGN YOUR NAME HERE:
Your answer
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