2026-2027 DIRT Nature School Enrollment

2026-2027 DIRT Nature School Enrollment
Child's First, Middle, and Last name
Child's Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's age at start of 2026 school year
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Registration options
Requested days of attendance (please select all that apply)
Child lives with:
Has your child attended any early education programs in the past? Please describe.
If applicable, what did you like or dislike about your previous experiences with early education programs?
How would you describe your parenting style?
Do you have any goals for your child at DIRT Outdoor School?
Is there anything about your family or your child that you would like to share with us? (all information provided is confidential)

Parent/Guardian 1
Name

First NameLast Name
Phone:
Email:
Confirm Email:

Parent/Guardian 2
Name (First and Last)
Phone:
Email
Confirm Email

Authorized Pickup and Emergency Contacts
Name, Relationship, Phone
Name, Relationship, Phone
Name, Relationship, Phone

Medical Information
Is there a medical action plan required? (Medical action plan must be updated on an annual basis and when changes to the plan occur.)
List any allergies and the symptoms and type of response required for allergic reactions.
List any health care needs or concerns, symptoms of and type of response for these health care needs or concerns.
List any particular fears or unique behavior characteristics the child has:
List any types of medication taken for health care needs:
Share any other information that has a direct bearing on assuring safe medical treatment for your child:

Emergency Medical Care information
Health Care Provider:
Office Phone:

Release of Liability, Assumption of Risk, and Permission Forms
From: [parent’s name] (herein referred to as the PARENT/GUARDIAN)
Regarding: (child's full name)
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

1. ACKNOWLEDGMENT AND ASSUMPTION OF RISKS - Informed Consent of Activities.
The PARENT/GUARDIAN acknowledges that their child will have the opportunity to engage in risky activities, which may include tree climbing, hiking on uneven and sometimes slippery or rocky grounds, tool use, fire tending, stick play, and many more activities in all weather conditions that have known and unknown dangers and risks associated with participation, including but not limited to, the risk of minor injuries such as cuts, bruises, and scrapes, insect bites, insect stings, weather associated injuries, and more, as well as the risk of serious injury or death. The undersigned and the participant(s) choose to voluntarily enter upon the premises and property upon which DIRT Outdoor School is conducted, knowing their present condition and knowing that said condition might become more hazardous and dangerous during the time the participant or the undersigned is upon said premises. The undersigned and the participant(s) voluntarily assume any and all risks of loss, damage, or injury that may be sustained by the participant(s) and/or the undersigned while on or upon said premises above. In signing this Release, the undersigned acknowledges: a) That they have read thoroughly, understands completely the terms of this Release, and signs it voluntarily. b) That the undersigned signing either for themselves, or as Legal Guardian is, in fact, the true and legal guardian of the child participant.
E-SIGNATURE OF PARENT/GUARDIAN

2. RELEASE AND WAIVER OF CLAIMS
The PARENT/GUARDIAN releases, holds harmless, waives, and fully discharges DIRT Outdoor School from any and all claims, demands, obligations, causes of action and liabilities of any kind arising from or connected to, directly or indirectly, any loss, damage, or injury, including death, that may be sustained by the child participant and/or the undersigned, while upon the premises upon which DIRT Outdoor School is conducted or engaging in DIRT Outdoor School programs. DIRT Outdoor School shall not be obliged to carry insurance on the participant(s) and the existence of insurance shall not change, alter, or increase the liability of DIRT Outdoor School to the participant(s) and the undersigned or affect the terms of this Release. In signing this Release, the undersigned acknowledges: a) That they have read thoroughly, understands completely the terms of this Release, and signs it voluntarily. b) That the undersigned signing either for themselves, or as Legal Guardian is, in fact, the true and legal guardian of the child participant.
E-SIGNATURE OF PARENT/GUARDIAN

3. INDEMNITY
The PARENT/GUARDIAN will indemnify and hold harmless DIRT Outdoor School from any damage, loss, liability, legal costs and other expenses that DIRT Outdoor School may suffer or incur by reason of any claims against DIRT Outdoor School. In signing this Release, the undersigned acknowledges: a) That they have read thoroughly, understands completely the terms of this Release, and signs it voluntarily. b) That the undersigned signing either for themselves, or as Legal Guardian is, in fact, the true and legal guardian of the child participant.
E-SIGNATURE OF PARENT/GUARDIAN

FULL RELEASE
I UNDERSTAND THAT, BY SIGNING THESE RELEASE AGREEMENTS, I GIVE UP IMPORTANT LEGAL RIGHTS, INCLUDING, BUT NOT LIMITED TO, THE RIGHT TO SUE. I UNDERSTAND THAT DIRT OUTDOOR SCHOOL IS RELYING UPON MY FULL RELEASE AND WAIVER OF ALL CLAIMS WHEN ALLOWING MY CHILD TO PARTICIPATE IN DIRT OUTDOOR SCHOOL PROGRAMS.
E-SIGNATURE OF PARENT/GUARDIAN

Photo/Video Release
I hereby give permission for pictures and/or videos to be taken of my child in the program setting to SHARE DIRECTLY WITH THE PARENT/GUARDIAN. (REQUIRED)
I hereby give permission for pictures and/or videos to be taken of my child in the program setting for use on BAND, the app we use to share daily updates with enrolled families. (REQUIRED)
I hereby give permission for pictures and/or videos to be taken of my child in the program setting for use on SOCIAL MEDIA platforms and OUTREACH materials. (OPTIONAL)

Permission Forms
I hereby give permission for sunscreen and insect repellant to be applied to my child as needed.
On occasion, DIRT Outdoor School may receive requests from other professionals to observe the program. We attempt to do this with the least disturbance to the children’s routine. I hereby give permission for my child to be present on these occasions.
In the event of an emergency that requires immediate action before I can be reached, I hereby give permission for DIRT Outdoor School staff to use their best judgement in the treatment/care of my child, including but not limited to, CPR, bandaging, taking child to the emergency room and administering medication to treat severe acute conditions such as allergic reaction, snake bite etc. (REQUIRED)
I have received and read the DIRT Outdoor School Parent Handbook. I understand the policies and procedures given to me and agree to adhere to all school expectations. I understand that policies and procedures are subject to change to reflect the needs of the program, children and families we serve. (REQUIRED)
E-SIGNATURE OF PARENT/GUARDIAN
Signature
Should be Empty:

2026-2027 DIRT Nature School Enrollment

Parent/Guardian 1

Parent/Guardian 2

Authorized Pickup and Emergency Contacts

Medical Information

Emergency Medical Care information

Release of Liability, Assumption of Risk, and Permission Forms

1. ACKNOWLEDGMENT AND ASSUMPTION OF RISKS - Informed Consent of Activities.

2. RELEASE AND WAIVER OF CLAIMS

3. INDEMNITY

FULL RELEASE

Photo/Video Release

Permission Forms