Grow Wild Association Summer Program 2023

Grow Wild Association

Summer Program 2023
Parent Name

First NameLast Name
Your Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
What week(s) would you like your child(ren) join us? Please note that we are closed on Fridays.

July 10-July 13July 17-July 20July 24-July 27July 31-August 3August 7-August 10August 14-August 17
Which days would you like your child(ren) to attend the above weeks?

MondaysTuesdaysWednesdaysThursdays
We have a sliding scale donation option of $65-85 per child. We offer $10 off per additional child. Please select the option most appropriate for you.

All 4 days-1 childAll 4 days-2 childrenAll 4 days-3 childrenDaily rate of $65-$85 for 1 childDaily rate of $65-$85 for 2 childrenDaily rate of $65-$85 for 3 childrenOther
Please write the daily donation that suits your financial needs ($65-85).
If you answered "Other" above, please write the dates and the number of children you will register for those dates.
How many children will be attending?
Name

First NameLast Name
Age of child above
Please list any allergies or medical concerns for this child.
Name

First NameLast Name
Age of second child attending if applicable
Please list any allergies or medical concerns for this child.
Name

First NameLast Name
Age of second child attending if applicable
Please list any allergies or medical concerns for this child.
Emergency Contact

Please provide two emergency contacts. Will we call in the order provided.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Grow Wild Association Policies and Procedures

We are holding our program outside in the open air. Please note that we will be utilizing an enclosed area (barn) for shade, rest, torrential rain cover, and/or other actvities deemed appropriate as needed.
We will have a flushing port-a-potty with water for hand washing or composting toilet.
We will send a list of items necessary for attendance, such as tick spray, change of clothes, and food items in welcome email following registration.
Each child must come with appropriate clothing for weather as we will be outside in all weather types (e.g., rain boots, rain coats or rain pants/suits, layers of clothing, hats). Please LABEL ALL with child's name or initials.
We have the right to deny any child/ren admittance due to illness, physical symptoms, or known exposure to COVID-19.
Your child(ren)'s participation may be discontinued if it is determined that they are exhibiting behavior that is dangerous, destructive, or consistently disruptive to the group. Every effort will be made on the part of Grow Wild Association to ensure that every child may be included.
Morning arrival is 9:00 am-9:20 am and afternoon pickup is 2:40-3:00 pm. A suggested donation of $30 will be owed if you drop off/pick up more than 5 minutes before/after these windows for mornings and afternoons, respectively.
A 25% deposit of total tuition is required for each child in attendance and must be received no more than 10 days following registration. This amount will be deducted from total donation. Acceptable forms of payment include cash or check (cash preferred). Please make checks payable to Grow Wild Association and mail to 1124 East Washington Road Hinsdale, MA 01235. All purchases are non-refundable and non-transferable.
Informed Consent

Grow Wild Association focuses on nature-based learning experiences, social-emotional wellness, and experiential education. All programs are available to members only. Membership is open to all families who wish to enroll in any of Grow Wild Association's programs.

While it is shown that outdoor trasmissionof viruses is low, 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 exhibits symptoms of fever, gastrointestinal issues, non allergy respiratory issues while at Grow WILD Association, you will be called immediately to pick up your child and will NOT receive a refund.

It is your responsibility to assess your child/ren's physical symptoms. Please keeep ill children home.

Acknowledgement of Release from Liability

I hereby give my approval for my child(ren)’s participation in any and all activities prepared by Grow Wild Association 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 GROW WILD ASSOCIATION (A "PROGRAM" FOR MEMBERS), I ASSUME ALL RISK AND HAZARDS INCIDENTAL TO THE CONDUCT OF ANY AND ALL PROGRAMS, AND INDEMNIFY, RELEASE, ABSOLVE AND HOLD HARMLESS GROW WILD ASSOCIATION 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 GROW WILD ASSOCIATION, 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.

Photo Release

I hereby give authorization to Grow Wild Association to use photographs or video or my child for promotional purposes for website and market purposes. I understand that my child will not be identified by name, nor will any compensation be extended for such use. If I prefer that photos or videos of my child not be used, I will contact Grow WildAssociation directly before my child attends.

Medical Release and Authorization

Grow Wild Association's staff are First Aid, CORI checked, and CPR certified. In the event that a medical situation is minor and/or necessary, I authorize Grow Wild Association 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 Grow Wild Association to have my child transported to the nearest medical care facility (BMC) and to secure necessary medical treatment for my child as determined by Grow Wild staff.

Confirmation

I 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, INFORMED CONSENT, AND THE MEMBERSHIP APPLICATION BEFORE MY CHILD(REN)'S PARTICIPATION. BY SUBMITTING THIS FORM, I WILLINGLY AGREE TO BECOME A MEMBER OF GROW WILD ASSOCIATION, A PRIVATE MEMBERSHIP ASSOCIATION.
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