Fall '20 KIN *POD* Enrollment Application
This is the POD ENROLLMENT Kin Application. By filling out this form you are asking us to keep your pre-selected group together. If you were looking to sign your child up, but don't already have a pod formed, no worries - just fill out our Open Enrollment application instead by following this link: https://forms.gle/WZmFFZ39ooP81XGW9

> I recommend all members of POD be on a conference call to fill this out, or send the information to one central parent.

We offer two options daily - an after-school program and a day program. The exact times for the after school program will be firmed up once we all learn the distance learning school schedule - which I believe will happen mid August.

Pods can more flexibly choose their time slots, so if you imagine a different schedule, the write it in "other" and we'll see if we can make it happen!

**IMPORTANT** Filling out this form does not guarantee enrollment or registration. Instead, it gives the program your information so we can build our roster. We will be in touch as soon as possible with official placements. Please wait for us to contact you. It could take up to a week.
Email address *
How many members do you have in your pod? *
Is your pod full or are you seeking another member? *
**POD MEMBER INFORMATION**
This section is a bit more complex - but for each pod member I would like your answer to look like this example:
>> Please keep Pod Student #'s Consistent. <<

YOUR NAME:
Pod Student #1
Full name, Age
Pod Student #2
Full name, Age

PRIMARY CONTACT PHONE AND EMAIL
Pod Student #1
Parent/Guardian name, Phone #, Email Address
Pod Student #2
Parent/Guardian name, Phone #, Email Address

EMERGENCY CONTACT NAME AND NUMBER
Pod Student #1
Parent/Guardian name, Phone #, Email Address
Pod Student #2
Parent/Guardian name, Phone #, Email Address

POD STUDENT NAMES AND AGES *
POD STUDENTS' PRIMARY CONTACTS' PHONE AND EMAIL *
POD STUDENTS' EMERGENCY CONTACTS' NAMES AND NUMBERS *
** CHOOSE YOUR PROGRAM DAY(S) **
Please select which day(s) you would like your Pod to participate.
Monday
Tuesday
Wednesday
Thursday
Friday
Medical History and Release
Students' Histories of Illness, Injury or ALLERGY >> [ Student Name, History] for each relevant student *
Medicines or Treatments Typically Used at Home >> [ Student Name, History] for each relevant student
Other Important Information About My Child: >> [ Student Name, History] for each relevant student
To insure that we all have a good time, it is imperative that the children are ready for the program. If you are able to say yes to the following requirements for each POD student confidently, then they're ready to go!
- Students are able to carry their own pack for the length of the program

- Students are potty trained and is comfortable with "nature potty" when facilities are not readily accessible.

- Students can be away from their parent for the length of the program.

- Students are capable of listening to instructions, and is willing to be silly and get a little dirty!

- Students will not act violently to their peers, teachers or self.
All children in this pod meet the above requirements: *
Required
Kids in Nature Waiver
Dear Kids in Nature Parent,

We are delighted you’ve chosen to enroll your child in our Program. We know they will enjoy and benefit from exploring the lovely habitat we all call home. As a parent of a participant we want you to know and understand the common hazards of outdoor exploration before we begin the journey together. Through participation in Kids in Nature your child could be exposed to poison oak, ticks, sun, roads, and the unexpected in nature. Children will also be climbing trees and walking through forests, which could result in tripping and falling due to uneven topography in wild landscapes. During the program, the children also cross roads in a carefully supervised group. Though occurrence is incredibly infrequent the forest is also home to many wild creatures and unexpected exposure to these animals could lead to injury or illness.

In the case of an emergency that cannot be treated in the field, it is Program Policy that Emergency Medical Assistance (911) be called, which may require an ambulance. Lead Teachers are Wilderness Medicine Certified and equipped with first aid kits and may address any minor injuries such as cuts and scrapes in the field. By signing this waiver you confirm that your child is covered by valid health insurance, and acknowledge the inherent risks involved in participation in this program.

By enrolling your child in our Program you assume such risks yourselves as well as on behalf of your child. Thus, by signing this form you agree that neither Kathryn Jaffe nor Kids in Nature or any of its employees or independent contractors is in any way legally or financially responsible for any injury, death, or illness, mentioned or unmentioned above, sustained by your child through participation in the Program and that you willingly consent to their participation in the Kids in Nature program.

Thank you.
Please sign your name below to agree to the above waiver on behalf of you and your child: (We will have other pod families sign this before participating.) *
Please check each box to certify that you can adhere to our COVID policies, and SIGN YOUR INITIALS IN THE COLUMN THAT SAYS "OTHER" - ALL POD MEMBERS MUST AGREE *
Required
Check this box if you are interested in your pod having an hour of homework help during their program hours. If we have enough folks who want that we can form a group that accommodates this option.
Thank you!
Thank you for registering! Let us know if you have any last questions! We look forward to meeting you and your little one....
A copy of your responses will be emailed to the address you provided.
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