Nomad Shadow Visit Registration Form
Please use this form to select a date for your child to shadow at Nomad. This form also asks you to provide medical/safety information and to agree to our terms and conditions for their shadow visit. If you have more than one child interested in Nomad, please complete this form separately for each child.
Child's full name *
Your answer
Child's Age *
Your answer
Gender pronouns used by your child
Your answer
Preferred shadow visit date (check all that work for you) *
Required
Full name of parent/guardian filling out this form *
Your answer
Child's Medical Information
Does your child have any medical conditions that we should be aware of for their shadow visit? If so, are there any actions that we might need to take to ensure their health and safety? *
Your answer
Food Allergy Action Plan *
Required
Safety Measures
Primary Emergency Contact - Name *
Your answer
Primary Emergency Contact - Phone Number *
Your answer
Primary Emergency Contact - Relationship to Student *
Your answer
Secondary Emergency Contact - Name *
Your answer
Secondary Emergency Contact - Phone Number *
Your answer
Secondary Emergency Contact - Relationship to Student *
Your answer
Consent to Medical Care
By signing electronically I hereby authorize NOMAD Education, LLC and the delegated leaders and directors to consent to any medical and hospital care to be rendered to said minor upon the advice of a licensed physician. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. It is understood that if time and circumstances reasonably permit, NOMAD Education, LLC will endeavor, but is not required, to communicate with the undersigned prior to such treatment. The undersigned further agrees that NOMAD and its designated leaders and directors are not legally or financially liable for any claim arising from any consent given in good faith in connection with such diagnosis or advised treatment. This authorization and consent to treatment of a minor is given to all representatives of NOMAD Education, LLC and shall remain effective from September 2018 through June 2019.
Click "I agree" to consent to the above medical care statement. *
Required
Photo Consent
Photo Consent

NOMAD Education, LLC takes photographs and/or videos of activities in or related to NOMAD classes and experience. These photographs and videos are used solely in support of NOMAD Education, LLC and its educational mission. Their uses include, but are not limited to, brochures produced by NOMAD, social media outlets, blog posts about our daily activities, our website, and press kits sent to media outlets to promote future or current programs for NOMAD Education, LLC. We would appreciate your cooperation in signing the following consent to all and any images of your child appearing in these photographs or videos to be used by NOMAD Education, LLC. By signing electronically, I hereby understand (a) the images and/or tape recordings will be used exclusively to promote the activities of NOMAD, (b) the images and/or tape recordings will be the sole property of NOMAD Education, LLC, and (c) there will be no wages or payment of any kind in return for this appearance.

Click "I agree" to consent to the above photo consent statement. *
Required
Transportation Agreement
NOMAD Education, LLC values field trips and excursions for learning purposes, project work, and content exploration. By digitally signing this agreement, you give your permission for your child to travel via public transportation, personal vehicles of NOMAD Education, LLC staff members, or personal vehicles of parent volunteers, and/or the NOMAD Education, LLC owned school bus with or without advance notice. While NOMAD Education, LLC will give advance notice about field trips or excursions whenever possible, we reserve the right to pursue opportunities as they arise without advance notice during the school day. By signing this agreement, you acknowledge that staff and parent drivers are insured, responsible, and will do everything in their power to ensure the safety of the students for whom they are responsible.
Click "I agree" to consent to the above statement about transportation. *
Required
Signed by: *
Your answer
Please digitally sign your name below to agree to the above information. *
Your answer
Release Form
In exchange for the minor child being allowed to participate in activities, projects, tool use, field trips, and experiments at NOMAD Education, LLC, the undersigned parent or legal guardian for himself or herself and personal representatives, assigns, heirs and next of kin (herein referred to as releasors), hereby releases, holds harmless, waives, discharges and covenants not to sue or bring any action whatsoever against NOMAD Education, LLC, its agents, employees (herein referred to as releasees) from all liability to the releasors, for all loss or damage and all rights and claims whether caused by negligence of releasees or otherwise while participating in activities associated with NOMAD Education, LLC.

The undersigned is fully aware of the inherent risks and hereby elects to participate voluntarily and assumes all risks of loss, damage for injury that may be sustained by his or her minor child.

The undersigned parent or legal guardian and minor child (participating in NOMAD activities) agree that they are physically able to participate in all activities based on a physician’s examination.

Please digitally sign (type) your name below to agree to the above information. *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of NOMAD. Report Abuse - Terms of Service