Chickadee AM Program

Chickadee Program (2.5-4yrs)

Please complete this waiver and registration form below before your first class.

Available Chickadee Programs

Monday Chickadee WINTER January 16th - April 3rd (12 Weeks)

$360.00CAD

Total

$0.00CAD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Parents Full name*

First Name Last Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number. This number will be our first line of contact.
Child's Full name*

First Name Last Name
Child's Date of Birth

MonthDay Year
Date
Emergency Contact Name & relationship to child *

First and Last Name Relationship to child
Emergency Contact phone number*
Please enter a valid phone number. This number would be our second line of contact if needed.
What area are coming from?
(i.e. Carleton Place, Kanata, Stittsville, etc...)
How did you hear about us?

Social Media (Facebook)Social Media (Instagram)A FriendFlyerOnlineOther
If a friend referred you, please share their name so we can thank them! (You can both take advantage of our refer a friend discount of $25 each for a future seasonal program)
First and Last Name
Health and Safety
Does your child have any allergies, sensitivities or medical conditions?
Does your child have any developmental or behavioral needs that would be beneficial for us to know?
Photo Permission
Do you consent to your child's photo being taken while in program?*

YesYes, but no face for social media useNo
Informed Consent Forms

Medical Treatment and Assumption of Risk
Medical/First Aid Consent

I consent to Wild Child Nature Project providing my child with any necessary medical assitance while in their care.

This may include, but is not limited to:

1) Treatment and care for scrapes, scratches, bumps and bruises. Insect stings, bites and allegeric reations may be treated with with Benadryl Spray for mild reactions and/or Children's Benadryl or Epi-pen for life threating reactions.

2) Providing and/or procuring emergency or urgent medical care including transportion of the child for treatment to the local emergency facility.

Parents/Guardians will be notified immediately should the need for emergency care arise.
Signature*

Clear
Risk Assessment Consent

In unstructured, outdoor play, children freely choose which experiences and forms of play they are comfortable engaging in. Your child is under no obligation to participate in all experiences and may choose not to participate at any time during the program.

At Wild Child Nature Project, we support children in becoming confident, capable people who have a sound sense of their abilities and interests, and the ability to take age-appropriate responsibility for their own safety.

We believe that unstructured outdoor play and learning are central to this program.

Wild Child Nature Project takes reasonable steps to manage and balance risks, while at the same time allowing children to play freely.

Program participants acknowledge its inherent risks of harm and personal injury. While minor injuries like bruises, bumps and scrapes are not uncommon, serious injuries are rare, and life-changing injuries and fatalities are unlikely in the extreme. Still, as with almost any activity, indoors or outdoors, it is impossible to guarantee that they will not happen. You are required to accept this as a condition of your child’s participation.

Risks

The variety of risks is more than can be listed here and can vary by activity and day. However, our educators are trained and experienced. Their role is to support children in learning and playing, while keeping the risks to a minimum. We provide an environment where the children can feel safe, in control and are trusted to make decisions for themselves.

We provide rules and guidelines that are designed to enhance the safety of your child and others and are to be followed at all times.

Below is a list of some of the more significant risks:

- Injuries resulting from the presence of harmful plants, natural loose parts, wild animals, and/or ticks
- Injuries from executing strenuous and demanding physical activities
- Injuries resulting from matches or fire
- Changing and inclement weather, including storms, high winds, and lightning
- The possibility that your child may not heed safety instructions or directions given to the group or delivered individually
- Injuries arising from the actions of other children
- Your child’s risk of injury increases with fatigue
Signature*

Clear
Should be Empty:

Chickadee Program (2.5-4yrs)

Health and Safety

Photo Permission

Informed Consent Forms