The Walden Year 2025-26 Registration

The Walden Year 2025-2026

Walden Year enrolls students ages 16-19 (11th grade-post grad) for full days 8:30AM to 3:30PM, Monday-Friday. Embedded in Vermont’s natural and human communities, Walden Year holds classes on the Willowell land, state parks, wilderness areas, rivers, libraries, town halls, community organizations, youth centers, and other places that make up Vermont’s landscape, culture and social structure. Walden Year inspires adolescent learners to cultivate their relationship to self, society, and the natural world. During each semester at Walden Year, 16-19 year-old students embark on different interdisciplinary explorations of science, society, mathematics, culture, art, literacy, technology and health through the lens of the Vermont landscape. Walden Year admits students and families of all socioeconomic status, race, ethnicity, religion, gender, sexual orientation, nationality, and ability/disability.
Student's Name*

First NameLast Name
Age*
Birth Date*

MonthDayYear
Date
Grade at the start of the 2025-26 school year:*

11th12thPost-gradOther
If you selected other, please elaborate:
Are you currently enrolled at Vergennes Union High School?*

YesNo
Gender
Preferred Pronouns
Student's Email*

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 school? 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 did you attend in the current or most recent academic year?*
Do you have an education plan such as an IEP or 504? Or have they developed a personalized learning plan you’d like to share with us?
Have you been diagnosed with any sort of behavioral or physical disability? If so, please describe it and suggest strategies you've found effective.
Do you require an aide or some sort of special consideration? Please explain.

Getting To Know You
Would you like us to add grandparents or any friends to our mailing list so they can be invited to events and receive updates? Please list names, email addresses, and phone numbers.*
What do you enjoy doing both outdoors and indoors? What are your interests?*
What are your self-care routines? Are there areas where you may need more support given the active and outdoor nature of the program?*
What are your strengths?*
What are your hopes for this year?*
Is there anything else you would like us to know about you ? Do you have any specific concerns or thoughts regarding 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 Walden Year activities;

3. Willowell programs are operated primarily outdoors and throughout the community, which is an integral part of the Walden Year 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 is injured 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

I authorize the Walden Year staff to administer to my child only the medications I have noted below. In the event of an accident or illness that in the judgment of Walden Year requires medical attention, I hereby authorize Walden Year 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 Walden Year for the expense of emergency treatment and/or ambulance service.
Medications:*
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 the Walden Year 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 Walden Year 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

Walden Year Contract and Registration Agreement
I/we* (hereinafter referred to as “Parent/Guardian”) agree to enroll our child * at Walden Year for the 2025-2026 school year.
I am enrolling my child for the full year. The 2024-2025 year is tuition-free. Willowell encourages participating families to consider donationing to help cover program costs. A suggested donation for the full school year would be $5,000-$10,000 for those able to do so. However, nobody will be turned away for lack of funds and Willowell's primary goal is to have anyone who wants to participate be able to do so. So go ahead and sign up!

Donations are accepted in single or recurring payments. Contact rowan@willowell.org with any questions. Willowell is a 501c(3) non-profit and donations are tax-deductible.

Failure of the above child to complete the remainder of the school year does not entitle the Parent/Guardian a refund of tuition or relieve the Parent/Guardian from their obligation to pay The Willowell Foundation. Parents/Guardians agree and understand that early withdrawal of the child from Walden Year requires written notification with a 30 day advance written notice. Failure to give written notification will result in forfeiture of your refund.

Willowell reserves the right to terminate this Enrollment Contract and un-enroll the child from this program with or without notice for any reason. Parents/Guardians agree and understand that termination of this Enrollment Contract and disenrollment of children from Walden Year does not change the refund provisions. Willowell reserves the right to adopt/amend rules and regulations as deemed necessary. The child and the Parents/Guardians shall comply fully with the rules and regulations as stated or amended in the Walden Year Policy Manual.
I HAVE READ AND AGREE TO THE TERMS OF THE ABOVE ENROLLMENT CONTRACT
Parent/Guardian A Signature*

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Date*

MonthDayYear
Date
Parent/Guardian B Signature

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Date

MonthDayYear
Date
*Please send donations via check, made payable to The Willowell Foundation. Be sure to include a memo about who and what it is for.

Do not make checks out to Walden Year.

Send checks to:

The Willowell Foundation

PO Box 314

Bristol, VT 05443
Should be Empty:

	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

The Walden Year 2025-2026

Medical Information

Immunization Records

Education History

Getting To Know You

Walden Year Contract and Registration Agreement

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