New Roots Spring 2025 Registration

New Roots Project Spring 2025

New Roots Project enrolls students ages 7-11, for full days 8:30AM to 3:00PM, Tuesday, Wednesday, and Thursday. We now have an extended care option that runs from 3:00-4:00PM. Embedded in Vermont’s natural landscapes, New Roots holds classes on the Willowell Land, in Monkton, inspiring young learners to cultivate their relationship to self, society, and the natural world. The program runs 3 days per week, from April 15th until June 12th (observing the MAUSD school calendar closings). Students can enroll for any number of days per week. New Roots Project admits families of all socioeconomic status, race, ethnicity, religion, gender, sexual orientation, nationality, and ability/disability.
Student's Name*

First NameLast Name
Age of Student*
Birth Date*

MonthDayYear
Date
Current grade level:*
Gender

Parent/Guardian A Name*

First NameLast Name
Email*
example@example.com
Preferred Phone Number*
Please enter a valid phone number.
Secondary Phone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian B Name

First NameLast Name
Email
example@example.com
Preferred Phone Number
Please enter a valid phone number.
Secondary Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Name (other than parent/guardian)*

First NameLast Name
Preferred phone Number*
Please enter a valid phone number.
Relationship to student*
Second Emergency Contact Name (other than parent/guardian)

First NameLast Name
Preferred phone Number
Please enter a valid phone number.
Relationship to student
Is there any other person authorized to pick up your student from New Roots? Please note them below.

First NameLast Name
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.

Other Comments

Education History
What school or home study program did your student attend in the current or most recent academic year?*
Does your student have an education plan such as an IEP or 504? Or have you developed a personalized learning plan you’d like to share with us?
Has your student been diagnosed with any sort of behavioral or physical disability? If so, please describe it and suggest strategies you've found effective.
Are there any other special considerations? Please explain.

Getting To Know Your Family
What do you and your student enjoy doing both outdoors and indoors? What are your family interests?
What are your student’s strengths?
What are your hopes for this session at New Roots?
Is there anything else you would like us to know? Do you have any specific concerns or thoughts around fears, likes or dislikes, or learning style?

MEDICAL WAIVER

By signing your names and the date below you agree and warrant, as follows:

1. You are the Student’s parent/legal guardian;

2. The Student is physically fit and able to participate in all New Roots activities;

3. Willowell programs are operated primarily outdoors, which is an integral part of the New Roots experience. Outdoor school attendance carries with it the inherent risks associated with being outdoors, which You accept on behalf of You and the student. One such inherent risk is exposure to ticks and, if bitten, tick borne illnesses, which can cause long term or permanent health effects. The best defense against students suffering tick bites, other than their wearing appropriate clothing, is regular, thorough inspections of students’ bare skin. Please check daily.

4. In the event the student suffers an injury or becomes suddenly ill, You consent to Willowell Foundation employees, agents, or other personnel (“Willowell) seeking, consenting to, and obtaining medical attention and treatment or other measures for the student as deemed necessary or advisable by Willowell in consultation with medical providers, regardless of whether Willowell is able to contact You in the interim.
Medical Waiver Signature (Parent/Guardian)*

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Date*

MonthDayYear
Date
MEDICAL RELEASE

In the event of an accident or illness that in the judgment of New Roots requires medical attention, I hereby authorize New Roots to contact my child’s physician and/or seek, consent to and obtain medical care, including transportation to a medical facility. I also do hereby authorize the physician and emergency room staff to administer care they deem necessary. I understand that every effort will be made to contact you first, but the inability to do so does not affect or the validity of the herein granted consent to seek, consent to and obtain necessary medical care.

I/we further agree to reimburse Willowell and/or New Roots for the expense of emergency treatment and/or ambulance service.
Medical Release Signature (Parent/Guardian)*

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Date*

MonthDayYear
Date
LIABILITY WAIVER

By signing your name/date below and clicking submit, You, the parent/legal guardian of the student, for good and valuable consideration, the receipt of which is acknowledge, represent, warrant, and agree, as follows:

1. I understand that New Roots takes place in outdoor terrain in rustic conditions, and in all types of weather. This could include potentially hazardous activities, such as hiking, wading, fire building, running, playing with foam swords, using sharp tools, and cooking over a fire, etc. 

2. I acknowledge that participation in this program is voluntary and that I and the student understand and assume the inherent risks involved in program activities. I and the student agree to obey all rules and policies mandated by program personnel.

3. I agree to release, hold harmless and indemnify the Willowell Foundation, its officers, directors, members, employees, and all other associated persons (“Willowell”) from any claims, damages, losses and/or expenses, including, without limitation, claims for personal injuries, property damage, sickness (including Covid-19), or even death (“Claims”) arising out of participation in program activities and to assume all liability for any and all such Claims.

4. This release, hold harmless and indemnification agreement extends to any and all Claims that may be brought by me, the student, or others in my family based on the actions, omissions, or even the negligence of Willowell that occurs before, during, or after participation in, or is in any way connected to any camp program.

5. In the event any claim is brought by or on behalf of me, the student, or a member of my family against Willowell, I/we agree to indemnify Willowell or any individual who may be named as defendant or party, for their attorney fees and any judgment rendered against them.
Liability Waiver Signature (Parent/Guardian)*

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Date*

MonthDayYear
Date
PHOTO WAIVER

By signing your name/date below, You, the student’s parent/guardian, authorize the Willowell Foundation (“Willowell”), to publish the photographs or video taken of the student (first names used only, if any), for use in printed publications, e-newsletters, videos, and on authorized websites (Willowell.org and the AmeriCorps website, Willowell Facebook and Instagram). I acknowledge that since this participation in media produced by Willowell is voluntary, we will receive no financial compensation. I further agree that the student’s participation in any media produced by Willowell carries no rights of ownership whatsoever to me or the student and I do hereby release Willowell and its officers, directors, members, employees/contractors, and associated personnel from any and all manner of liability for any and all manner of claims by me, the student or any third party in connection with their participation.
Photo Waiver Signature (Parent/Guardian)

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Date

MonthDayYear
Date
EMERGENCY CARE AND TRANSPORT WAIVER

I, (name of parent/legal guardian) understand every effort will be made to contact me in case of emergency. I hereby authorize the staff and teachers of New Roots to obtain emergency medical care and transport for my child if deemed necessary for (Name of child).
Emergency Care and Transport Parent/Guardian Name*
Emergency Care and Transport Student Name*
Emergency Care and Transport Waiver Signature (Parent/Guardian)*

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Date*

MonthDayYear
Date
KNIFE AND TOOL SKILLS WAIVER

We will teach basic knife and tool safety to all students and allow those students who have parental permission to use tools such as saws, chisels, and drills (but not limited to this list). By signing below the parent/legal guardian agrees I/we wish to have our Student be taught knife and tool skills. If you do NOT wish to have your child learn knife skills please leave the field below blank to indicate below that you do not.
Knife and Tool Skills Waiver Signature (Parent/Guardian)

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Date

MonthDayYear
Date

	Name of medication	How often?	What condition is the medication treating?	Will the student need at school?*
Medication 1
Medication 2
Medication 3
Medication 4

New Roots Project Spring 2025

Medical Information

Education History

Getting To Know Your Family

Registration

Optional: Extended Care

New Roots Contract and Registration Agreement

I HAVE READ AND AGREE TO THE TERMS OF THE ABOVE ENROLLMENT CONTRACT

*Please only check the below payment boxes if you are paying by credit card. If you are paying by check, skip the below section and click continue.