Instinct Memory - Wild Quest Camp

- Homeschool Rewilding Class
  
  by Instinct Memory
- Location: The Cotter
  
  Wednesday class
  
  time: 9am - 1pm
  
  Week 1: 1st October
  Week 2: 8th October
  Week 3: 15th October
  Week 4: 22nd October
  No class on 29th October
  Week 5: 5th November
  Week 6: 12th November
  Week 7: 19th November
  Week 8: 26th November
  
  What to bring:
  
  - sun protection, hat
  
  - raincoat
  
  - enclosed weather proof shoes
  
  - water bottle
  
  - morning tea and lunch
  
  class options:
  
  1. Casual class per child = $45 (paid at time of booking)
  
  2. 8 week term per child = $280 (paid in advance)
- Are you the parent or guardian of children?
- Parent/Guardian name:*
- Mobile Number:*
  Format: (+61) 400000000.
- E-mail*
  
  Confirmation Emailexample@example.com
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip CodeCountry
- Number of Adults*
  The number of adults from your family who will be attending
- ParentGuardian
- Adult 1 First Name
- Adult 1 Family Name
- ParentGuardian
- Adult 2 Family Name
- Adult 2 First Name
- GrandparentOther
- Adult 3 First Name
- Adult 3 Family Name
- GrandparentOther
- Adult 4 First Name
- Adult 4 Family Name
- Number of Children*
  The number of adults from your family who will be attending
- Child 1 Name*
- Child 1: Date of Birth*
  DD/MM/YYYY
- Child 2 Name*
- Child 2: Date of Birth*
  DD/MM/YYYY
- Child 3 Name*
- Child 3: Date of Birth*
  DD/MM/YYYY
- Child 4 Name*
- Child 4: Date of Birth*
  DD/MM/YYYY
- Child 5 Name*
- Child 5: Date of Birth*
  DD/MM/YYYY
- Emergency Contact Name:*
  
  First NameLast Name
- Emergency contact Mobile Number:*
  Format: (+61) 400000000.
- NoYes
- Please specify allergies and who it relates to*
- At Instinct Memory we are committed to providing a supportive environment for all participants. If you or your child have any needs for learning adaptation e.g. neurodivergence (ADHD, autism, dyslexia and others) or perhaps other needs we should be aware of to help create the best possible experience, please let us know below. Sharing this information is entirely optional and will be kept confidential. Please specify any support strategies that may assist.
  Anything you'd like to share for us to be aware of so we can adapt for you, your child/children where possible
- 1. Acknowledgement of Risk
  
  I acknowledge that participation in bush skills workshops, nature-based activities, and related outdoor experiences involves inherent risks, including but not limited to:
  
  Physical injury from natural terrain, wildlife, use of tools, or fire;
  
  Exposure to variable weather conditions;
  
  Accidents resulting from walking, climbing, building shelters, crafting, and fire-making activities.
  
  I accept that while all reasonable care is taken by Sam Harris (Instinct Memory) to provide a safe environment, risks cannot be eliminated entirely.
  
  2. Release and Indemnity
  
  In consideration of being permitted to participate, I:
  
  Release and forever discharge Sam Harris (Instinct Memory) and the property owners, from all claims, demands, and proceedings arising out of or in connection with any loss, injury, or damage suffered as a result of participation, to the fullest extent permitted by law.
  
  Indemnify and hold harmless Sam Harris (Instinct Memory) and Ingelara Farm against any liability, loss, or expense arising out of participation.
  
  3. Participant Responsibility
  
  I agree to:
  
  Follow all instructions provided by workshop and class facilitator/s.
  
  Take responsibility for my own safety and the safety of any minor children under my care.
  
  Notify Sam Harris (Instinct Memory) of any medical condition that may affect participation.
  
  4. Photo and Video Consent
  
  I understand that photographs and videos may be taken during the event, which may include images or footage of my child/children to be used by Instinct Memory on social media platforms, websites, and promotional materials.
- I consent to the use of photographs/videos of my child/children for the purposes outlined aboveI do not consent to the use of photographs/videos of my child/children for the purposes outlined above
- I have read, understood, and voluntarily agree to the terms of the Waiver, Risk Acknowledgement, and Privacy Notice provided. If signing on behalf of a child/children, I confirm I am the parent or legal guardian and consent to their participation.
- Please select option:*
  prevnext( X )
  
  Homeschool Rewild casual class (Wednesday)
  $45 per student
  
  $45.00AUD Quantity
  
  Homeschool Rewilding 8 week term (Wed)
  $280 per child
  
  $280.00AUD Quantity
  
  Total
  
  $0.00AUD
- Total balance to be paid today:
- Payment details: Bank account Name: Sam Harris BSB: 923-100 Account Number: 305735485:*
  Please use this format as your transfer reference e.g. WQFirstName_LastName. Please copy payment receipt details here.
- Anything else you'd like to share?
- Should be Empty:

Homeschool Rewilding Class