Treeline Enrichment / TimberNook West Central Florida Participant Information: Liability, Release, & Consent

Big Kid Forest Play Registration
Get ready for an immersive forest play program especially designed for big kids (ages 11-14). This is a program that celebrates the joy in play, the exploration in nature, and the importance of social connections. With large group games and discussions to springboard interactions and thinking, kids will be invited to make the woods their own by using their creativity, problem solving skills, the natural environment around them, and (very) simple loose parts.

Big Kid Forest Play program themes for fall 2023 include:
⛺️Shelter Building
🔥Fire Starting
🧭Navigation
🧵Creative Repairs

Fall 2023 Schedule:
Wednesdays October 4, 11, 18, 25
9:00-12:00 pm
Ages 11-14

Important Details:

Is this Program a Good Fit for Your Child?
We welcome all kids to participate in fores play programs, regardless of developmental, social, or emotional skills. We do require that children:
- Are able to function with a 1:6 adult-to-child ratio and in a setting with up to 24 kids
- Are able to stay within the general, unfenced group area in the woods without frequent reminders
- Maintain personal safety with adults notably stepped back and NOT within arm’s reach.
- Maintain appropriate behavior that does not endanger the safety of other children (or staff) or compromise the play of other children.
When you register your child for a Treeline forest play program, you are verifying that (to your best knowledge) your child is able to be successful with ALL FOUR above points. If you are unsure if your child is a good match for a program, please schedule an informational call by clicking here.

Program Notes:
- This is a drop-off program.
- You will receive a comprehensive welcome packet (emailed to the email account you register with) a week in advance with complete information on where to go, what to wear, what to bring, and what to expect.
- We understand that life happens and plans change, but please understand that all payments, are non refundable.
- One or more team members on site are CPR/First Aid Certified.
- This program is staffed at a 6:1 child to adult ratio. All staff are background checked and fingerprinted.
- A primitive camp toilet is available.
  Treeline Enrichment programs and services are 100% outdoors. Weather-appropriate attire is required.
- We are located in Southeast Plant City on over 10 acres of natural woods, a pine tree farm, grassy fields, and more. 701 Sparkman Road, Plant City, FL 33566.
Child's Name

First NameLast Name
Your Child's Birth Date*

MonthDayYear
Parent / Guardian (the primary contact for this child)*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number

Other Adults Authorized to Pick Up Your Child (Government issued photo ID required). If this section is left blank, no other adults can pick up your child.

	Name	Phone Number	Relationship to Child

Please tell us something about your child (personality, interests, hobbies, etc.) *
Does your child have (health issues):*

AsthmaBreathing problemsmedical conditions or other issuessensory processing disorderheart problemsphysical or developmental challengesautismnone of the above
Please explain any health/developmental issues checked above. If none, please indicate. *
Does your child use an inhaler or take any medication? *

YesNo
Please list any ALLERGIES your child has and indicate severity of allergies (specific reaction to allergen, use of epi-pen, etc.). Be sure to include ANY food allergies or sensitivities as some of our programs incorporate open fire cooking or snack preparation. If none, please indicate. *
Is there any other condition that we should be aware of that may endanger, alter, or somehow limit your child's abilities to participate in any nature program? *
Is your child current with their immunizations? (This question is important only if there is an emergency situation and we need to communicate with emergency personal)*

YesNo
Consent for Medical Treatment

In the event that I cannot be reached in an emergency requiring medical attention for the above named child, permission is hereby given for the staff of Treeline Enrichment, LLC whom are CPR/first aid certified to administer CPR and/or first aid as deemed necessary. Further permission is given to allow medical services to be performed by doctors, hospitals or other qualified medical providers as deemed necessary in an emergency, including surgery if reasonably necessary. I understand that the cost of all emergency services is my responsibility.Note: If you have any medical condition that Treeline Enrichment, LLC should be aware of it; is your responsibility to let us know of the existing condition prior to the start of any program. The information will be held in confidence and used only to render assistance should the need arise.
Please sign your full name. I have read and consent to medical treatment, should it be needed. *

Clear
Photo Release

Occasionally photos and video-taping will be taken during program and may be used for Treeline Enrichment, LLC print and digital publications including but not limited to its website and social media pages. However, we will not identify your child by name or release any personal information.
Do you give permission for Treeline Enrichment, LLC to take pictures/video of your child?*

I do GIVE permission to have my child's picture/video takenI do NOT GIVE permission to have my child's picture/video taken
Sun Screen / Bug Spray
Do you give permission for Treeline Enrichment, LLC staff to reapply sunscreen and bug spray through the day as needed?*

YesNo
Liability Release Wavier and Authorization Form
LIABILITY RELEASE WAIVER AND AUTHORIZATION FORM.

Participation at a Treeline Enrichment, LLC exposes participants to certain risks of being in the outdoors. Accidents and injuries resulting from the forces of mother nature, live animal and bug interactions, slipping and falling, malfunctioning equipment, unseen obstacles, fatigue, and your own and others’ misjudgment are very real possibilities.

AFFIRMATION AND LIABILITY RELEASE THE UNDERSIGNED CERTIFY THAT THEY AGREE AS FOLLOWS:

1. I hereby affirm that I have been informed that there are inherent dangers of being outdoors at a nature program.

2. While all program participants are consistently well supervised, accidents do happen. The undersigned(s)assume(s) all risk of injury or harm to any member of our family associated with participation in the program and agree(s) to release, indemnify, defend and forever discharge Treeline Enrichment, LLC and its staff, employees, and agents of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action in respect of death, injury, loss or damage to the family member, or by the family member, howsoever caused, arising or to arise by reason of or during the family member's participation in the program.

3. I hereby agree to heed at all times the advice and instructions of the Treeline Enrichment, LLC and its owners to practice common sense while at this program.

4. The above-named participants, including all minor children have permission to participate in the activities of Treeline Enrichment, LLC.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my family’s participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against the Treeline Enrichment, LLC on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read & understood it, and I agree to be bound by its terms.
I have read, understand, and agree to the liability release wavier and authorization form.*

Yes
Please enter your full name below. By doing so, you agree that this serves as your legally binding electronic signature on this form and your agreement with Treeline Enrichment LLC policies, the liability waiver, and consent statements*

First NameLast Name
Please sign your full signature

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My Products

Big Kids Forest Program$156.00

Wednesdays 9-12pm October 4, 11, 18, 25, 2023

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Big Kid Forest Play Registration

Consent for Medical Treatment

Photo Release

Sun Screen / Bug Spray

Liability Release Wavier and Authorization Form