Program Waiver
Please complete this form in its entirety. Must be updated annually. The Trailhead appreciates your support!
Enrollment Date *
MM
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DD
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YYYY
Child's Name *
Your answer
Child's Date of Birth *
MM
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DD
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YYYY
Age *
Your answer
Allergies/Health Conditions/Other Concerns *
Your answer
Medications *
All medications must be in original packaging with label. Prescription medications must include doctor's prescription and pharmaceutical label. Please include written administration schedule or circumstances.
Your answer
Child #2 Full Name
First,Last
Your answer
Child's #2 Date of Birth
MM
/
DD
/
YYYY
Child #2 Age
Your answer
Allergies/Health Conditions/Other Concerns #2
Your answer
Medications #2
All medications must be in original packaging with label. Prescription medications must include doctor's prescription and pharmaceutical label. Please include written administration schedule or circumstances.
Your answer
Preferred Hospital *
Your answer
Hospital Address *
Your answer
Hospital Phone *
Your answer
Preferred Dentist *
Your answer
Dentist Address *
Your answer
Dentist Phone *
Your answer
Preferred Physician *
Your answer
Physician Address *
Your answer
Physician Phone *
Your answer
*Note: Due to our new licensure protocol, current Immunization Records and Health Records must be filed for every child attending programming with the Trailhead Children’s Museum. Please attach, bring in hand, or mail to PO Box 1508, Crested Butte, CO, 81224.
Payment Form *
Cancellation Policy: 3 days noticed is required for any cancellations. If cancellation is less than 3 days from program/camp/class/drop off no refund will be given. If the program requires a minimum number of participants to run (noted on product description) no refund will be given if you cancel. A participant absence is not transferable to another date and no refunds are given due to unplanned absence or late cancellation.
Required
Parent #1 Full Name *
First, Last
Your answer
Best Phone Number to Reach Parent #1 *
Your answer
Mailing Address Children/Parent #1 *
Your answer
Physical Address Children/Parent #1
Your answer
Email Parent #1 *
Your answer
Parent's #1 Employer
Your answer
#1 Employer Address
Your answer
#1 Employer Phone
Your answer
Parent #2 Full Name
First, Last
Your answer
Best Phone Number to Reach Parent #2
Your answer
Mailing Address Parent #2
Your answer
Parent's #2 Employer
Your answer
Employer Phone #2
Your answer
Employer Address #2
Your answer
Emergency Contact #1 *
Your answer
Emergency Contact #1 Phone # *
Your answer
Emergency Contact #1 Address *
Your answer
Emergency Contact #2 - MUST FILL OUT TWO EMERGENCY CONTACTS! *
Your answer
Emergency Contact#2 Phone # *
Your answer
Emergency Contact #2 Address *
Your answer
Persons Authorized For Pick-up #1: Name, Address, Phone Number *
Your answer
Persons Authorized For Pick-up #2: Name, Address, Phone Number *
Your answer
Persons Authorized For Pick-up #3: Name, Address, Phone Number *
Your answer
Persons Authorized For Pick-up #4: Name, Address, Phone Number *
Your answer
I authorize The Trailhead to use electronic media (TVs, Computers, Handheld Devices, etc.) as a teaching aide. *
Authorization for child to check himself/herself in or out of Trailhead Programming. (check box for signature) *
Required
Member *
Please read the Parent Agreement and click "I agree". *
Thank you for your understanding and adhering to our policies!
Required
Parent Agreement
I am interested in volunteering for The Trailhead
This Waiver is valid for ONE YEAR from date of submission. If any information changes, please fill out a new form, email info@trailheadkids.org with changes, or call us at (970) 349-7160. Thank you!
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