Child name (last, first): *

Grade: *

Classroom teacher (last name only): *

Parent name(s): *

Parent email:

Parent phone number (222-333-4444): *

I am aware that the Howe Music Retreat will be taking place June 6 - 8, 2018, at Timberline Ranch in Maple Ridge, BC, and would like my child to participate. *

I am aware that the cost to participate in the retreat is $200, and agree to pay before May 15th, 2018 *

Please check all dietary restrictions that apply to you: *

If you checked 'Other' in the previous question, please describe below:

Please list any food-specific allergies your child has:

Please list any medications that your child takes as part of a prescription schedule mandated by a doctor, or in case of allergic emergency (for example, EPI-pen): *

I agree to equip my child with all items they will need for the retreat as detailed in the "Items to Bring" list that will be provided. I will discuss any special circumstances with Mr. Noftle prior to the retreat.

I want my child to participate in supervised horseback riding while at the retreat. *

I have discussed with my child, and agree to the high standards of behaviour that will be expected for the duration of the music retreat, and am aware that behaviour issues may require me to come and get my child during the retreat to take them home, as decided by Mr. Noftle, in consultation with the parent supervisors.

As a parent, I am available and willing to come to the retreat to assist with child supervision. I understand this will require a police record check (please start this process immediately), and meeting with Mr. Noftle for itinerary planning and supervision training. *