Foxwalk Forest School - Open House Registration
Please complete one form for each child you are registering for the Open House.
Contact Info
Child First Name *
Your answer
Child Last Name *
Your answer
Address (Street) *
Your answer
Address (Town) *
Your answer
Address (State) *
Your answer
Address (Zip) *
Your answer
Address (Other Info)
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender
Your answer
In case of emergency, please contact:
Name of First Contact *
Your answer
Phone 1 *
Your answer
Phone is:
Phone 2
Your answer
Phone is:
Email *
Your answer
Relationship
Name of Alternate Contact
Your answer
Phone 1
Your answer
Phone is:
Phone 2
Your answer
Phone is:
Email
Your answer
Relationship
Family Physician Name
Your answer
Family Physician Phone
Your answer
Please list and describe any Allergies, Medications, Physical Challenges, or Behavioral Issues:
Your answer
RELEASE, INDEMNIFICATION AND WAIVER FORM
At Vermont Wilderness School the safety of each student is our highest priority. We take all reasonable precautions to ensure your child’s physical and emotional safety and to provide a quality experience that focuses on fun, safety and character development. However, as in any other experience, we cannot eliminate all risk from our programs. By signing the following statements you will be acknowledging that you understand the risks of attending Foxwalk Forest School, assuming liability for your child’s participation and certifying that your application is complete and truthful.
Release *
By checking here, you are consenting to the use of an electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right.
Required
Parent / Guardian Signature *
Type your name here.
Your answer
Donation
A donation of $20 is requested, but not required.
I will be be making a donation via:
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