Four Winds Registration Form

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Our Updated Covid Policy* This field is required.

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Our Core Beliefs & Guiding Principles* This field is required.

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Have we met your child/ren before?* This field is required.Have you attended one of our summer program weeks or at a family event?

YESNO

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Do you need to schedule an interview?* This field is required.If we have not previously met you at one of our events or open houses, we will need to meet you face to face before we can complete your enrollment application. Please contact us to make an appointment, please note our interview days are free of charge

YESNO

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Which days would work for your family's visit and interview?

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How did you hear about us?Please let us know how your found out about our programs. Select all that apply.

A friend told me

Facebook

Instagram

Google search

Poster/flyer

Other

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Previous Educational Experience?Please select which type of education your child/ren have previously experienced. Select all that apply.

Public School

Home School

Private School

Alternative Education

Unschooling/Sudbury

Forest School

Montessori

Steiner/ Waldorf

Other

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Do you have more than one child signing up?You may fill in this registration for up to 3 children, if you wish to sign up 4 or more please contact us.

YESNO

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Briefly tell us about your children* This field is required.

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Child 1- Information* This field is required.Please tell us about your child

First Name

Middle Name

Last Name

Age

Gender

Birth Date

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Health or Special Diet* This field is required.Please let us know if there is anything we need to be aware of in regards to your child's health

Child's Name

Allergies

Dietary Restrictions

Mental or Emotional Issues

Physical Health Issues

Anything else you need to let us know about?

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Child 2 - Information Please tell us about your child

First Name

Middle Name

Last Name

Age

Gender

Birth Date

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Child 2 - Health or Special DietPlease let us know if there is anything we need to be aware of in regards to your child's health

Child's Name

Allergies

Dietary Restrictions

Mental or Emotional Issues

Physical Health Issues

Anything else you need to let us know about?

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Child 3 - InformationPlease tell us about your child

First Name

Middle Name

Last Name

Age

Gender

Birth Date

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Child 3 - Health or Special DietPlease let us know if there is anything we need to be aware of in regards to your child's health

Child's Name

Allergies

Dietary Restrictions

Mental or Emotional Issues

Physical Health Issues

Anything else you need to let us know about?

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Your Family's Address* This field is required.Where do your children primarily reside?

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Parent/ Guardian 1* This field is required.

First Name

Last Name

Please enter your phone

Please enter your email

Your Relationship to Student

Your address if different than students otherwise enter "not"

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Parent/ Guardian 2* This field is required.

First Name

Last Name

Please enter your phone

Please enter your email

Your Relationship to Student

Your address if different than students otherwise enter "not"

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Emergency Contact 1* This field is required.In case of an emergency and we cannot reach a Parent or Guardian, who do we need to contact?

Name

Relationship to Student

Please enter their phone

Please enter their email

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Emergency Contact 2In case of an emergency and we cannot reach a Parent or Guardian, who do we need to contact?

Name

Relationship to Student

Please enter their phone

Please enter their email

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Consent to TreatIn case of injury my child(ren) may be treated with: Select all that apply.

Homeopathy only

Herbal Medicine only

Traditional first aid only

All Three

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First Aid Care:In case of injury my child(ren) may be treated with the following supplies: Select all that apply.

Band aids

Topical Antibiotic ointment

Hydrocortisone ointment

Cleansing wipes

Medical tape

I would like to supply my own first aid options

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Difficult Behavior?* This field is required.Have any of your children had a difficult time getting along with others? Have they ever been asked to leave a class, school or other educational program?

YESNO

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Tells us about the difficult BehaviorPlease give us some details about the situation and the subsequent actions taken. Please specify the child's name if you have more than one child

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Our Fall Program options are: Homeschool Monday-Friday from 9:00-3:00, After-school Tuesday-Thursday 3:30-5, Saturdays 10-3.

Once you register we ask that you commit for the full 12 week program.

We do have rolling admissions if you have found us after the program has started.

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Select the program options in which you'd like your child(ren) to participate.

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Home-school tuition rates

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After-school tuition rates

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Preschool tuition ratesOur preschool mornings are Wed & Fri from 9:30-12 for parent and child. These sessions run for 4 week blocks. Choose either Wed or Fridays or both. If you are interested in dropping your child off for the preschool mornings, there are a few limited places, please add a note with this application.

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Saturday tuition ratesPlease choose from our Infant/toddler Family Mornings or our Saturday adventures for older children ages 5+

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Confirm Your SchedulePlease tell us again which program you are registering for and the days and times that work for you.

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Confirem

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Will you need financial aid beyond our sliding scale fees?It is important to us that every child who wants to be a part of the program is able to attend, regardless of being able to pay. However we have to cover our running costs. Financial aid is based on both the needs of the family and the Learning Community. For any kind of financial aid, either scholarship or work exchange, a family must fill out a financial aid application. There are two ways to receive tuition aid at Four Winds; either through direct scholarship (if available) or through exchanging actual work for tuition. Work Exchange is available depending upon the needs of the school and the skills available among the applicants. For example, there are always some cleaning, yard maintenance and farm jobs available. We also often have larger jobs to be done which might entail carpentry or plumbing,etc If a work exchange is approved and accepted, families will be financially responsible for uncompleted work exchange hours. Parents and/or guardian(s) of any student who withdraws or changes his or her program will be obligated for full payment.

YESNO

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Would you like to be a parent volunteer?This means being present during our sessions and assisting the teachers.

YESNO

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Additional Comments or QuestionsPlease let us know if there is anything else we need to know about your family in order to serve you better. Or if you have any other questions about our programs. Please also use this section to tell us about your child's learning strengths, struggles, passions, etc.

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Winter Conditions & Extreme Weather* This field is required.In the event that our program is disrupted by extreme weather, this is our protocol: -Rain & snow we will be outside and under our shelter spaces, wearing warm protective clothing. We may also have fires to keep warm and enjoy the natural world. -Should a thunderstorm come up, with visible lightning strikes, we will take shelter with the children and ask families to come and collect their children as soon as possible. We will teach the children and ask them to maintain the lightning safety pose until they are able to get into their families vehicle. -In the event of a tornado we will shelter in the basement of our house with masks on until it is safe to come out. -If temperatures should drop below 20F, we may have to cancel the day or end our sessions early for the safety of the children. We will keep in touch with families via text messages for snow days and other weather related delays or cancellations. We are unable to refund these sessions. If we go over 3 weather cancellation days per program, we will make these up in the end of the semester. Please confirm that you understand our winter closure policy.

YESNO

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Photo Release * This field is required.Four Winds Learning Community has my permission to use photographs/ videos of my child for any legal use, including but not limited to: publicity, advertising, fundraising, social media, grant applications and web content. I understand that my child will not be identified by name, nor will any compensation be extended for such use. Please SELECT ONE

GRANTDO NOT GRANT

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Liability Release & Medical Authorization* This field is required.I hereby give my approval for my child(ren)’s participation in any and all activities prepared by Four Winds Learning Community (FWLC) during the selected program dates/times and understand that there may be times my child(ren) may not be in direct supervision. As children will be active, playing, exploring, and risk-taking, they may get hurt. Risk of injury includes, but is not limited to, fractures, paralysis, and death. BY REGISTERING MY CHILD(REN) IN SELECTED DATES/TIMES AT FWLC (A "PROGRAM"), I ASSUME ALL RISK AND HAZARDS INCIDENTAL TO THE CONDUCT OF ANY AND ALL PROGRAMS, AND INDEMNIFY, RELEASE, ABSOLVE AND HOLD HARMLESS FWLC AND ALL ITS RESPECTIVE MANAGERS, MEMBERS, LESSORS, OFFICERS, DIRECTORS, EMPLOYEES, AFFILIATES, AGENTS, CONTRACTORS, AND REPRESENTATIVES FROM ANY AND ALL CLAIMS, LIABILITY, OR INJURIES TO SAID CHILD(REN) ARISING OUT OF, TRAVELING TO, PARTICIPATING IN, OR RETURNING FROM ANY AND ALL PROGRAMS. IN NO CASE SHALL FWLC, MANAGERS, MEMBERS, LESSORS, OFFICERS, DIRECTORS, EMPLOYEES, AFFILIATES, AGENTS, CONTRACTORS, AND REPRESENTATIVES BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, PUNITIVE, SPECIAL, OR CONSEQUENTIAL DAMAGES ARISING FROM ANY CLAIM RELATED IN ANY WAY TO YOUR CHILD’S PARTICIPATION IN A PROGRAM. In the event that a medical situation is minor and/or necessary, I authorize Four Winds to care for my child. In the event that a situation requires medical attention, I will be called immediately. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize Four Winds to have my child transported to the nearest medical care facility (BMC) and to secure necessary medical treatment for my child as determined by Four Winds staff. Please confirm that you are aware of the risks involved and grant approval.

YESNO

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Covid Cancellation Policy* This field is required.Please be aware of our policies in the event that we have to suspend our classes due to a Covid outbreak in our community. You are registering your child at your own risk. If for any reason it is deemed necessary that we close, your reservation will be canceled, you will be notified immediately, and will be issued a 50% refund. If your child or anyone they have been in close contact with is exhibiting symptoms of COVID-19, you should not register or you should inform us immediately. If your child exhibits symptoms of fever, gastrointestinal issues, or non-allergy respiratory issues while at Four Winds, you will be called immediately to pick up your child and will NOT receive a refund for their visit. If a community member tests positive and there’s been known exposure with other members, we will notify parents/guardians. We will decide next steps (e.g., to close or remain open) based on careful consideration of situation. In the event that the decision is made to close Four Winds for possible COVID-19 exposure, we will offer a refund of 50% for said closure time. If we decide to stay open and you are not comfortable with our decision, we will offer a refund of 50% should you decide to keep your child home. We will encourage all children to get tested prior to return. If you must miss our program due to a Covid-19 issue within your home, you will be required to pay 50% for days missed. Please confirm that you understand and agree.

YESNO

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Payment Policy* This field is required.Payment is due by the final Thursday of each month. When you register for our program semester you are committing for the full program (i.e. twelve weeks in the Fall Program, etc). If your child misses days of our program, you are still responsible for paying in full. If you need to cancel, please do so with a week's notice of the start of our program, then you will not be charged except for your non-refundable deposit. If you cancel with less than a week's notice you will be responsible for paying 1/2 of the full fee of the program.

YESNO

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SignatureI HAVE READ AND ACCEPT THE POLICIES AND PROCEDURES, INFORMED CONSENT, ACKNOWLEDGEMENT AND RELEASE FROM LIABILITY, PHOTO RELEASE, AND MEDICAL RELEASE AND AUTHORIZATION. BY SIGNING AND SUBMITTING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE AND WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. I WILL ALSO SIGN PAPER COPIES OF RELEASES AND INFORMED CONSENT BEFORE MY CHILD(REN)'S PARTICIPATION.

Clear