Registration for Earth Path Program in Wakefield - Fall 2018
Welcome to Earth Path's weekly nature program in Wakefield! In order to secure your child's spot, please send in your payment ($100 deposit or full payment) at the time of registration. Payments can be sent by cheque in the mail or by e-transfer. If mailing your payment, we need to receive it within 1 week of your online registration.

To send payment by e-transfer, email to: Corinne@EarthPath.ca

To send payment by mail, make cheque payable to "Earth Path" and mail to:
Earth Path Wakefield
c/o Corinne McEachern
5 ch. Tom Harvey
La Pêche, QC J0X 1A0

Payment policy: A non-refundable $100 deposit is due at the time of registration. The remaining payment of $580 is due by August 14 (except for payment plan holders). After August 14, regrettably no refunds can be issued, unless we are able to fill your child's space. Please see Cancellation Policy below. If in need of a scholarship, payment plan, or reduced rate, contact Corinne@EarthPath.ca. Thanks for registering!

Program registering for: *
Required
Participant's Full Name *
Your answer
Date of Birth (DD/MM/YYYY) *
Your answer
Participant's Age *
Your answer
My child's gender is...
Your answer
Languages Spoken *
Required
Mailing Address (House #, Street Name, Town, Province, Postal Code) *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Mother's or Legal Guardian's Full Name
Your answer
Father's or Legal Guardian's Full Name
Your answer
Adults Authorized for Pick-Up *
Please list the names of adults who are authorized to pick up your child.
Your answer
Emergency and Health Information
If a parent/guardian cannot be contacted in an emergency, please contact:
Name of Emergency Contact *
Your answer
Phone Number *
Your answer
Name of Child's Physician and Physician's Phone Number (if applicable) *
Your answer
Does your child have any allergies or dietary restrictions? If so, please specify. *
Your answer
Does your child carry/need an EpiPen and know how to use it? *
Your answer
Is your child allergic to bee or wasp stings? *
Required
Date of last immunization for tetanus *
Or N/A if never been immunized for tetanus.
Your answer
I give consent for my child to receive the following as needed (please check all that apply): *
Required
Does your child have any special needs (e.g. physical, mental, or emotional)? We would like to know how best to support your child, including how to relate to him/her. *
Your answer
Other Useful Information For Us
What do you hope your child will learn from this experience?
Your answer
What experience does your child have outdoors?
Your answer
In what learning environments does your child do best? Do you have any concerns or suggestions about his/her behavior in groups? Does your child have any exceptionalities requiring special education?
Your answer
For participating children: What types of activities that we offer are you excited to do/learn? Is there anything else you would like to tell us? 



Your answer
Cancellation Policy
If you cancel before or on August 14, we will reimburse you fully, minus the $100 non-refundable deposit. After August 14, regrettably no refunds can be issued, unless we are able to fill your child's space.
Informed Consent Agreement and Safety and Release Form
In order to attend an Earth Path program, our Informed Consent Agreement and our Safety and Release Form must be completed for each child. These forms can be downloaded from our website and mailed in, or they can be completed on the first day of the program. Please arrive 5 minutes early if you plan to complete the forms on the first program day. Thanks!
Mailing List
Would you like to subscribe to Earth Path's mailing list to receive seasonal updates on our programs/events? *
We typically send 1-2 emails per season, and you can unsubscribe at any time by emailing info@EarthPath.ca with the subject line "Unsubscribe".
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