Hawthorn Farm: Adult Program Registration, Release & Waiver Form

Hawthorn Farm Adult Program Registration Form
Program Name *
Program Start Date *

Month Day Year
Date
Name of Participant *

First Name Last Name
Age *
Gender and Pronouns *

Female she/her Male he/him Non-binary they/them
Name of Participant *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
How did you hear about our programs? *
What are your hopes for yourself for this program? *
Please describe your gifts and passions
Do you have any special needs we should know about in order to serve you better?
Please tell us anything else you would like us to know.

Hawthorn Farm Participant Release

Emergency Contact Information
Name *

First Name Last Name
Relationship to Participant *
Phone Number(s) *

Area Code Phone Number
Medical or other conditions we need to know about? Please list and describe Allergies, Asthma, Diabetes,recent injuries or hospitalizations, current medications, or any physical or mental limitations:
Participant Signature *

Clear
Participant Name *

First Name Last Name
Dated *

Month Day Year
Date

Congratulations, you're almost finished!

To save your space, please click the button below to submit this form, and send full payment as listed in the program description to: Hawthorn Farm, 17340 NE 195th, Woodinville, WA 98072.
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Hawthorn Farm Adult Program Registration Form