Registration for Earth Roots Apprenticeship for Teens - Winter 2019
Welcome to the Earth Roots Apprenticeship for Teens, offered in partnership by Earth Path and Rivers and Roots! We are thrilled that your child will be joining us on this journey to deepen their understanding of the natural world, connect with peers, and themselves. We are excited to accompany your teen on a journey during which they will explore their gifts, develop confidence, leadership and inner zen, and learn awesome wilderness survival and naturalist skills. To secure your child's spot in the program, please complete all sections of this form with your child, then submit your deposit or full payment. Let us know if you need to take advantage of any of our Affordability options (scholarships, reduced rates, payment plans). Thanks, and see you in the woods!
Which program is your child registering for?
Please confirm that your child can attend all the sessions of the Earth Roots Apprenticeship (click the weekends/days your child can attend). Let us know if there are any your child cannot attend. *
Required
How do you wish to pay?
Participant's Full Name *
Your answer
Participant's Age *
Your answer
Languages Spoken *
Required
Mailing Address (House #, Street Name, Town, Province, Postal Code) *
Your answer
Phone Number *
Your answer
Parent's/Guardian's Email Address *
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 Your 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
Is your child taking any medications and/or require an EpiPen? *
Your answer
Does your child have any medical conditions that might affect her/his ability to participate fully in this active outdoor program? *
E.g. Any condition that would prevent her/him from hiking, carrying moderately heavy loads, sleeping outside, and walking distances greater than 2 km in variable weather conditions?
Your answer
Does your child have any special physical, emotional or learning needs that you would like us to be aware of? *
Your answer
Other Useful Information For Us
Broadly speaking, what do you hope your child will gain from this apprenticeship?
Your answer
What experience does your child have outdoors?
Your answer
For participating teens: what do you hope to learn or gain by joining this apprenticeship? What are you excited about?
Your answer
Informed Consent Agreement and Waiver of Liability
In order to attend an Earth Path program, our Informed Consent Agreement and Waiver of Liability Form must be completed prior to the start of the program. The form can be downloaded from the Earth Path website and mailed in or signed/scanned and emailed in. Thanks!
Cancellation Policy
1. Cancellations 3 weeks (21 days) or more prior to the start date of the program will receive a full refund, minus the deposit.
2. Cancellations between 3 weeks (20 days) and 1 week (7 days) prior to the program start date, will be refunded 50% of the program fee.
3. Cancellations less than a week (6 days) prior to the program start date will not be refunded.
Declaration of Parent/Legal Guardian (for underage teens)
By signing below, I declare that I am the legal guardian of the participant being registered for this program. I declare that the information supplied by me on this form is, to the best of my knowledge, true and correct. I understand and agree to the Cancellation Policy stated above.
E-Signature (print full name below) *
Your answer
Mailing List
Would you like to subscribe to Earth Path's mailing list to receive seasonal updates on our programs/events? We typically send 1-3 emails per season, and you can unsubscribe at any time by emailing info@EarthPath.ca with the subject line "Unsubscribe".
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