Sage Programs Registration Form

Sage Programs Registration Form
Welcome Friends of Sage Programs ~

Please read this form thoroughly and complete it BEFORE submitting payment. Payment alone will not secure your spot in a program. You must submit this form first. This form, in the next section, tells you if a space is available still in the program you are looking to register in.

Please fill this form out individually for each program you register for, even if it's for the same child.

To be considered fully registered:
1. Complete this online Registration Form (If the camp says sold out do not register and instead please contact us at programs@sagehamilton.com to join the waitlist)
2. Submit deposit
3. Tour our property to ensure that you are ok with the risks of your child's participation (if you have not already visited).
Additionally, for KinderHeart registrations (PLEASE NOTE DO NOT FILL THIS OUT TO REGISTER FOR SUMMER CAMP. IT IS FOR KINDERHEART ONLY):

4. Click on this link to print and fill out the "KinderHeart Program Tuition Contract"

PAYMENT OPTIONS:
Upon completing this form you will see the links to make your online payment(s)

IMPORTANT Refund Policies:

For Kinderheart's refund policy refer to the Kinderheart Tuition Contract

Camp refund policy

If camp is canceled before it starts due to COVID, you will receive a full refund.

Otherwise, after submitting your registration form and Initial Deposit (or Full Tuition), if you decide to withdraw:
- IF YOU CANCEL BY APRIL 19TH, 2023:
  You will receive a full refund of any payments made minus a $100 administrative fee.
- IF YOU CANCEL AFTER APRIL 19TH, 2023:If we are able to fill your space from our waitlist, you will receive a full refund of any payments made minus a $100 admin fee.
- If we are *unable* to fill your space from our waitlist, you are responsible for the full tuition and will receive no refund.
THIS FORM INCLUDES
-  Registration Info
- Medical Treatment and Emergency  Information Form 
- Hold Harmless Agreement
- Photo Release
 Warmest Regards,

 Sage Hamilton 

Director, Sage Programs

Registration & Contact
Which program would you like to register for?*
How did you hear about us * ?
Child's Name:*

First NameLast Name
Child's Birthdate*

MonthDayYear
Date
Child's Current Age*
Parent #1 Name:*

First NameLast Name
Parent #1 Phone*

Area CodePhone Number
Parent #1 Email*
example@example.com
Parent #1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent #2 Name:

First NameLast Name
Parent #2 Phone

Area CodePhone Number
Parent #2 Email
example@example.com
Parent #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sibling (s)
Name (s) and age (s)
Emergency Contact (besides parents)*

First NameLast Name
Emergency Contact Phone*

Area CodePhone Number
Relationship to Child*

Child's Medical & Emergency Information
Health Practitioner Name*

First NameLast Name
Health Practitioner Phone*

Area CodePhone Number
Past injuries, chronic illness, other...*
Taking the following regular medications (allopathic or herbal or other)*
Allergies (including food)*
Any other information you feel would be helpful for us to know in case of an emergency.*
Is your child potty trained (Potty Training includes, going to the bathroom on their own, wiping and putting paper in the toilet, washing hands, changing clothes if necessary on their own.)?*

YesNo
Medical Treatment Release Form
I hereby give my permission that my child may be given emergency treatment by a qualified staff member of Sage Programs. I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment.

In the event that I cannot be contacted, I further consent to the medical, surgical, and hospital care, treatment, and procedures to be performed for my child by a licensed physician or hospital to safeguard my child’s health.
Child's Name*

First NameLast Name
Parent's Name*

First NameLast Name
Parent's Signature*

Clear
Date*

MonthDayYear
Date

Our Property
We at Sage Programs strive to offer children and their families a nurturing,
natural environment for work, play, and festival gatherings. There is a sincere striving to watch out for everyone’s safety, however natural environments just have risks.

We ask that you walk our grounds and house prior to the program and sign this Hold Harmless Agreement.

IMPORTANT: Your space in the program will be held by filling out this registration form and providing payment, but your registration is not finalized until you complete a mandatory tour of our property.
Have you toured the property at 1545 Upland Ave, Boulder, CO 80304?*

YesNo. I will email programs@sagehamilton.com to schedule a tour
Hold Harmless Agreement
I assume the risks present to my child in both the indoor and outdoor environments at 1545 Upland Ave, Boulder, CO 80304

These risks include, but are not limited to:
Use of the Trampoline, Tree Climbing, and participation in Games, Free Play, and Movement Activities. All involve risk or injury from falls or collision with other participants.

Use of property both indoors and outdoors involves known and unknown risks such as injury due to the failure of equipment or other items used in an activity, risks from improper use of equipment, risks from slippery surfaces such as mud, snow or ice.

Sati, our dog, is very much a part of the programs and we welcome the opportunity for our child to be able to play with a loving, friendly dog; however we realize and accept the risks involved in playing with a dog.

As well, I agree to hold harmless Sage Programs for program activities off the Program grounds including: hiking, swimming, and camping as well as transportation in vans or private automobiles as authorized by Sage Programs.
Child's Name*

First NameLast Name
Parent Name #1*

First NameLast Name
Parent Name #2

First NameLast Name
Parent Signature #1*

Clear
Parent Signature #2

Clear
Date*

MonthDayYear
Date

Photo Release
I give permission for Sage Programs to use photos of my child and our family for purposes of non-commercial illustration, fundraising, and Sage Programs website viewing.
Child Name*

First NameLast Name
Parent Name*

First NameLast Name
Parent Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Sage Programs Registration Form

Registration & Contact

Child's Medical & Emergency Information

Medical Treatment Release Form

Our Property

Hold Harmless Agreement

Photo Release