BC Art of Mentoring 2019 REGISTRATION
Please COMPLETE a FORM for EACH FAMILY MEMBER, and then SUBMIT PAYMENT to secure your space in the program.

Payment can be sent via ETRANSFER (MUST include GST) to info@wisdomoftheearth.ca
or
PAYPAL through the webpage shopping cart at http://www.wisdomoftheearth.ca/art-of-mentoring-payment/.

Once we receive your registration form, you should receive a confirmation email. Please contact us at info@wisdomoftheearth.ca if you have any questions.

A detailed INFORMATION EMAIL about the Art of Mentoring, including logistics, directions, what to bring and how to prepare, will be sent out in June.

Note: Response fields marked with an asterisk are REQUIRED. Put NONE if not applicable.

Email address *
Name of Participant (one form is required for each participant) *
Your answer
Age (by August 1, 2019) *
Your answer
Which AOM program will you be participating in? (if you're not sure, ask us!) *
Full Mailing Address (only need to fill in once per family)
Your answer
Cell Phone
Your answer
Home Phone *
Your answer
Please list the first names of other family members who are attending with you (you must still fill in a form for each person). *
Your answer
Health Information
All health and medical information is kept confidential (may be shared with relevant staff) and is meant to provide a supportive and safe atmosphere for all involved in the program. Responses are required. If there are no health concerns, please write "none".
Emergency Contact Name and Phone Number (one per family is fine)
Your answer
Physician Name and Phone Number
Your answer
Medical Care Card #
Your answer
Do you/participant have asthma and/or any life-threatening allergies? If so, do you/they carry medication, an inhaler, or an epi-pen? (please explain) *
Your answer
Do you/participant have a heart condition? If so, please describe your limitation, medications (if any) and history. *
Your answer
Any allergies/Intolerance to any insects, plants, foods, medications, etc? List below. Briefly describe reactions to any of the above, especially of serious. *
Your answer
This program includes outdoor physical activities such as hiking on uneven ground, playing active games, camping, and exposure to the elements. Do you/participant have any physical conditions that may limit or impact participation in this program? If so, please describe: *
Your answer
List any prescription medications that you/participant take, the condition prescribed for, the doses and schedules for any such medications, and any known drug reactions. Do you/participant experience any side effects? *
Your answer
Are there any mental, emotional, psychological, or family issues we should be aware of? *
Your answer
Dietary Information
Our nourishing and beautiful food is a vital part of the AOM experience!

Meals will be mostly organic, with as much local farm fresh produce as possible, and may include wild salmon and carefully sourced chicken and meat.

Our kitchen team does their best to support a diversity of diets, though we are not necessarily able to meet very specific dietary requirements. Please contact us if you have any serious concerns that are health specific (vs personal preferences).

We plan and order food based on this information and ask that you stick with it throughout the week and support your children in doing the same. For example, if you put vegetarian, please do not choose fish or meat options, etc. There will be wide variety of food choices at each meal.

Please choose the option that most closely fits your dietary preference. You may choose more than one. *
Required
Additional comments (explain "other") and list any serious food allergies.
Your answer
PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK
To meet our insurance requirements, ALL PARTICIPANTS OF WISDOM OF THE EARTH PROGRAMS ARE REQUIRED TO SIGN A HARD COPY WAIVER BEFORE PARTICIPATING IN ANY PROGRAM.

These waivers will be available to signed at reception upon ARRIVAL at the AOM program, and MUST be signed at that time for each family member participating in the Art of Mentoring. You MUST be willing to sign this waiver to participate.

TO REVIEW the WAIVER IN ADVANCE, please visit this Google Document, or request an emailed version. Feel free to print it out and bring signed copies to facilitate registration on arrival.

https://drive.google.com/file/d/1hH1zh7spOB0jlyYxxAm4BLCl6dVFBvkU/view?usp=sharing

I have read and agree to these terms and conditions, and will submit a signed waiver upon arrival at the Art of Mentoring: *
Required
Media Release
I hereby grant free permission for Wisdom of the Earth Wilderness School to use images of myself or my child participating in their programs or events for educational, promotional, and outreach purposes, including but not limited to photo, audio, and / or video media. Please consider granting this release to us if at all possible, as our ability to successfully share our programs with new participants depends on having representative media. *
Additional comments or notes to Wisdom of the Earth staff:
Your answer
Thank you! You should receive a confirmation email. Please go to http://www.wisdomoftheearth.ca/art-of-mentoring-payment/ to complete payment for your registration.
A copy of your responses will be emailed to the address you provided.
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