Youth Registration 2022

Welcome to the Youth Programs Registration Page!

Contact info@humannatureschool.org if you have any questions.

Thank You for Supporting Human Nature School!

Primary Guardian*

First Name Last Name

Phone Number*

Area Code Phone Number

Email*

example@example.com

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Back Up Phone Contacts*

	First Name	Last Name	Phone
Secondary Contact
3rd Party Contact

List anyone you authorize to pick up your child(ren) other than yourself

Which Programs?

Homeschool Tuesdays, April 5th-June 7th, 10 wks, Ages 6-12, $400Forest Kindergarten Wednesdays, Sept 7th- Oct 25th, 8wks, ages 4-6, $250Homeschool Thursdays, April 7th-June 9th,10wks, Ages 6-12, $400

Choose Program/s*

Student(s) Info*

	First Name	Last Name	Birth Day	Tetanus	Medications	Has Asthma	Nut Allergy	Bee/Wasp Allergy	Other Allergies	Heart Condition	Other Limitations	History of yes's	Immunization Status
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Winter Homeschool Program*

Anything else you would like us to know about your child(ren)?

PHOTO/VIDEO RELEASE: Select below if you grant permission for Human Nature School to use still or motion picture images of yourself and/or my child(ren) participating in their programs or events for outreach purposes, including but not limited to electronic or print materials, or print or broadcast media.

I grant photo/video release*

YesNo

RELEASE, INDEMNIFICATION AND WAIVER FORM: (This is a release – please read it carefully.)

I, the undersigned, hereby acknowledge that I have been advised and fully understand that certain elements of danger are inherent in the activities sponsored by Human Nature School which are beyond the control of the instructors, agents, officers, students, and employees of Human Nature School, and that participation in any program activities may entail unavoidable risk of personal injury, death, and loss of or damage to property. These risks include, but are not limited to insect and animal bites and stings, forces of nature such as but not limited to lightning, and unexpected extreme weather conditions, and any hazard present in the wilderness, such as but not limited to low lying branches, sharp objects, and slippery surfaces. I hereby assume all risks of injury and death to those named above and loss of or damage to property arising out of my participation in such activity and I agree to indemnify, hold harmless Human Nature School, its officers, instructors, volunteers, agents, and employees (“Releasees”) from and against all claims arising from any occurrence causing damage or injury to myself or to any party participating in said event or any third parties injured as a result of my actions. In case of injury, parents or the emergency contact person will be called immediately for their decision on medical treatment. If parents or the emergency contact person is not available, we will use our best judgment as to what course of action to pursue and will continue to attempt contact. The camp or our organization will not be responsible for any costs incurred as a result of illness or injury. Parents should notify camp if this camper is exposed to any communicable disease during the three weeks prior to camp attendance. Prior to signing below, I have read and understand the terms and conditions of this Release, Indemnification, and Waiver, understand by signing below I am waiving certain legal rights I may have against the Releasees, and I agree to subscribe to all the terms and conditions set out above.

Your Signature*

Clear