Spring 2023

Medical/Health Information
Does your child have any food, medication or environmental allergies?*

YesNo
Please list and explain any allergies
Does your child's allergy require an Epi Pen

YesNo
Does your child have a special health or medical condition?*

YesNo
If your child has a special health or medical condition, please explain here.
Please provide any additional information about your child that would be useful for Roots 2 Rise staff to be able to best support your child's needs (i.e. emotional, cognitive, behavioural, physical, etc.)

Name*

First NameLast Name
Signature*

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Date*

MonthDayYear
Date
Thank you for your interest in Roots 2 Rise Outdoors!

Once your group has the minimum participants required for confirmation, the payment information, waiver and program information package will be sent to you.
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Registration Form - Spring 2023