Applegrove Nature School Registration & Waiver

Which program are you registering your child for?*

If you selected "drop-in" above, please specify the program & date(s):

Name of the Child*

First NameLast Name

Child's Birth Date*

Name of the Parent/Guardian*

First NameLast Name

Parent/Guardian's Contact Information*

Phone Number

Email Address

Street Address

Town

Emergency Contact Information*

First Name & Last Name

Phone Number

Does your child have any allergies?*

YesNo

If you selected "yes" above, please provide more details, including medication and emergency procedures.

If your child is taking any medications or has any health problems or limitations (eg. hearing, speech, vision, physical or emotional difficulties, etc.) that might affect their participating in the program, please provide more information below.

The safety of Applegrove Nature School students is our top priority. During nature school, the educator’s role is to make sure the group is physically safe and comfortable. We also assess the overall safety of the site and the risk management required for specific activities.

In consideration of the services of Applegrove Nature School, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf, I (Parent/Guardian of Student) hereby agree to release, indemnify, and discharge Applegrove Nature School, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:

1. ACKNOWLEDGMENT AND ASSUMPTION OF RISK
I acknowledge and agree that I am aware that there are many known and unknown dangers and risks associated with participation in the outdoor nature program including, but not limited to, the risk of minor injuries such as cuts, bruises, and scrapes, insect bites, insect stings, as well as the risk of serious injury or death. I acknowledge and agree that I understand the aforesaid dangers and risks associated with the outdoor nature program and notwithstanding such dangers and risks agrees to provide my permission for the Student to participate in the outdoor nature program. I expressly agree and promise to accept and assume all of the risks existing in this activity. My and my children’s participation in this activity is purely voluntary, and we elect to participate in spite of the risks.

2. RELEASE AND WAIVER OF CLAIMS
I hereby voluntarily release, forever discharge, and agree to indemnify and hold Applegrove Nature School from any and all claims, demands, or causes of action, which are in any way connected with my and my children’s participation in this activity or my use of Applegrove Nature School’s equipment or facilities or facilities which they use or rent, including any such claims which allege negligent acts or omissions of Applegrove Nature School or any persons acting on their behalf.

3. INDEMNITY
Should Applegrove Nature School or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. I certify that I have adequate insurance to cover any injury or damage I or my children may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I or my children may have

4. MEDICAL CONDITIONS
If you or the Student have any personal medical conditions or problems that Applegrove Nature School should be aware of, it is your responsibility to acquaint us with the existing condition at the registration for the program. All information gathered will be held in confidence and used only to render proper assistance to you should the need arise.

5. FIRST AID
I hereby authorize Applegrove Nature School, in the event of a perceived emergency, to administer first aid to the child and transport or arrange emergency transport to a medical facility for medical treatment.

I have read and agree to these terms and conditions.*

Yes

Payment Schedule Policy

In order for the child to participate in the program the full fee has to be paid before the start of the program. Payments can be made in cash or via e-transfer to BackToNatureBC@hotmail.com.

Cancellation and Refund Policy

If a child is unable to attend the program, 4 days notice are required to receive a full refund. If a child withdraws from the program more than 48 hours but less than 4 days prior to the first class, a 50% refund will be given. No refund will be given with less than 48 hours notice. If a day’s program must be canceled due to educator illness, a full refund for the day will be issued.

I have read and agree to these policies.*

Yes

I hereby grant permission for Applegrove Nature School to use images of myself and my child participating in their programs or events for outreach purposes, including but not limited to photo, audio and/or video media.*

Yes, you may use pictures of my child/meNo, you may not use pictures of my child/me

Electronic Signature

First and Last NameDate

Registration & Waiver

PARTICIPANT AGREEMENT, RELEASE ANDASSUMPTION OF RISK