Taste of Forest Forest School “A Taste of Forest School” Registration Form A series of Forest School Sessions for ages 6-10 year olds. February 21st and 28th; March 21st and 28th at the Old School in St. Williams (67 Queen St W). Each session $65. All 4 sessions $220. Participant Name * Name First First Last Last Age * Date of birth * Sex * Male Female Mailing address * Mailing address Mailing address Mailing address Town Town Province Province Postal Code Postal Code Parent / Guardian 1 Name Name First First Last Last Place of employment Email address Home phone Work phone Mobile phone Parent/ Guardian 2 Name Name First First Last Last Place of employment Email address Home phone Work phone Mobile phone Alternate emergency contact (if a parent cannot be reached) Name Name First First Last Last Relationship to participant Home phone Mobile phone Participant release permissions Person(s) to whom the participant MAY be released: Person(s) to whom the participant MAY NOT be released: Medical Doctor's name Doctor's address Doctor's phone number Child's health card number Does your child have allergies? Yes No If yes, please explain Emergency Procedures or Specific Instructions for above Does your child have any health problem or limitations that would affect their participation in programs? (hearing, speech, physical or emotional delays) Is your child on any medications? Yes No If yes, provide details My child will be responsible for her/his own medication I agree Other information about your child you wish to provide Authorization If at any time emergency medical treatment is necessary for my child, I give consent for treatment to be given. Every effort will be made to contact parent/ guardian(s) and/or emergency contacts. Please initial in consented space. Yes No Note: In the event of a serious illness or injury, your child will be sent to Simcoe General Hospital or Brantford General Hospital (dependent on which Forest School location). I understand that there is risk involved in participating in an activity or program and I acknowledge that my choice to register my child in the above named program brings with it the assumption by me of those risks. Please initial in consented space. Yes No I consent to my child’s photo being taken using photograph or video. I further understand and authorize that pictures taken at camp may be used for promotion (i.e. social media, print media, NCEE publications and website, and other forms for advertising and promotion). I hereby waive any right to inspect or approve the finished product or advertising or other copies that may be used in connection therewith or the use to which they may be applied. I understand that this material remains the property of Nature’s Calling Environmental Education. Please initial in consented space. Yes No Payment The program cost is $65/day/child. The program runs from 9am – 4pm. Advance payment options include: monthly, or by seasonal term. Payment must be received prior to start of camp. Days attending: February 21 February 28 March 21 March 28 Payment options * Interac e-transfer Cash Cheque E-mail address to send e-transfers to: info@naturescalling.ca Cheques should be mailed at least one week in advance to: Nature’s Calling Environmental Education P.O. Box 995 Simcoe, ON N3Y 5B3 Cancellation and Refund Policy If a day’s program must be cancelled due to educator illness or inclement weather, a full refund for the day will be issued. Nature’s Calling will make every effort to notify parents (by email, telephone, text) as soon as possible so alternate arrangements for their child can be made. Student Behaviour While the focus of our programming is on fun and learning, there are some behavioural expectations for students to ensure everyone receives an enjoyable experience. To ensure the safety of all Norfolk Forest School program participants: physical violence, harassment, bullying or foul language will not be tolerated. Parents/guardians will be notified if their child’s behaviour is inappropriate. If such inappropriate behaviour continues, NCEE reserves the right to remove the child from the Program and to refuse any further participation. No money will be refunded. If a student is not able to participate in a collegial and friendly manner, or is not willing to behave in a way that means other students are impacted by their behaviour, the parents will be notified. Every attempt will be made to keep a participant in the Spring Camp but, should the behaviour continue, NCEE reserves the right to remove the student from the program. Definitions of inappropriate behaviour and unsafe behaviour are defined in NCEE’s policies and handbook, which is available on request. Assumption of Risk and Consent I, the undersigned Parent / Guardian of Child's name * do hereby consent to her/his participation in the Spring Break Camp. I understand that the camp occurs in a mainly outdoor environment. I understand all program daily commencement and completion times. I also understand that I must be timely in my drop off and pick-up of my child. I am aware that there are potential risks and hazards associated with my child’s participation in NCEE programs. I understand that the hazards include, but are not limited to: Outdoor Environment: Navigation in unfamiliar territory; slips, trips or falls; trees and other natural objects. Allergic Reactions: allergic reactions resulting from contact with cultivated or wild plants; food or drinks; spider, tick or insect bites. Physical Activities: bumps, collisions, falling, tripping, bruises, broken bones, sprains, eye injuries; failure to play safely within one’s own ability. Weather: changing weather conditions; wet weather; snowy weather; the effects of heat or strong sunlight. Other Hazards: the possibility that my child, or others do not heed safety instructions or restrictions given to them. I acknowledge that accidents may occur during my child’s participation in NCEE programs and can occur without fault on either the part of my child or NCEE staff. I am aware that NCEE will take all necessary safety precautions and will attempt to minimize any risks associated with program activities. Accidents however, may cause loss of personal property, injury or even death. I understand that my child is expected to be respectful and considerate to other participants and NCEE staff, and must adhere to the rules with regard to student behaviour as set out above. I further understand that inappropriate behaviour on the part of my child may result in her/his removal from Norfolk Forest School and that I will not receive any refund of fees. I understand that my child will be solely responsible for her/his personal property and effects during Norfolk Forest School and acknowledge that it is recommended that valuable items are not brought on to the property. I also release Nature’s Calling Environmental Education and their staff / volunteers from any claim arising from such risks. Parent / Guardian 1: Please type your full name * Date Parent / Guardian 2: Please type your full name * Date If you are human, leave this field blank. Submit