2025-2026 HNS Student INFORMATION AND WAIVER

Student QUESTIONNAIRE AND WAIVER

Please update annually.
Student's Name*

First NameLast Name
Nickname
Student's Pronouns
Birthdate of Student

MonthDayYear
Date
Please check the program your child will attend.

Coyote School Program for Ages 6-12Forest Kindergarten for Ages 4-6Blair Elementary School After School ProgramTraverse Heights School After School ProgramWoodland School After School Program
If student is in Forest Kindergarten (Ages 4-6) are they able to use the toilet independently? If no, we will need you to accompany them at Human Nature School.

PRIMARY CONTACT
Primary Name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

ADDITIONAL CONTACTS AUTHORIZED FOR PICK-UP/EMERGENCY
Contact #2 Name*

First NameLast Name
Contact #2 Phone Number*
Please enter a valid phone number.
Contact #2 Relation to Child*
ie parent, aunt, friend, ect...
Contact #3 Name

First NameLast Name
Contact #3 Phone Number
Please enter a valid phone number.
Contact #3 Relation to Child
ie parent, aunt, friend, ect..

MEDICAL HISTORY
Does the child have any allergies?*
Please describe the allergies
Will the child need to take any medication during their HNS program?*
Please describe the medication to be taken
Has the child ever been stung by a bee?*
Was there a strong reaction to the bee sting?
What is the immunization status of the child? This question is required by Michigan Law and does not impact your child attending our program.*

Immunizations are currentImmunizations are mostly currentImmunizations are not up to date
Any other medical conditions that HNS needs to be aware of?*
Please describe the medical condition(s):

ADDITIONAL STUDENT INFORMATION
Is there anything else you would like us to know about your child?

PERMISSION CONFIRMATION
I give my permission for my child’s photograph or video to be taken for use by the Human Nature School on their website, social media, and/or promotional materials.*
I give permission for sunscreen and/or bug spray to be administered and/or applied to my child as deemed necessary by HNS staff. Please apply before they arrive at the day for an initial application. *
Safety Policies for Human Nature School Activities

Please review these policies and sign below. If they are not followed, you may be asked to pick up your child early.

Sunny Weather

Please avoid aerosol sun blocks and insect repellents. In a group, these can cause problems.

Tree Climbing

- Always ask before you climb
- Look out for dead parts of a tree where wood can break easily
- Do not go higher than your own height

Fire Starter Policy

- Full bucket next to fire
- Only walking in fire area
- No, walking on bricks
- No backpacks or sticks in circle
- Only two fire starters at a time
- Hair tied back with hair tie, Or in a Hat
- No loose clothing
- Fire is fully out we leave for the day

Knife Use Policy
- Nine and up are able to use real knives. Children eight and under use butter knives or plastic with soap for practice.
- Children have direct supervision, where teachers are watching and not carving.
- Lessons with levels 1,2 and 3: Level 1 is one on one, level 2 is a couple children with one instructor, and Level 3 enables take home practice and independence with skill
- Knives are checked by instructors
- No folding knives for carving
- Red cord is used to mark circle of safety aka “blood bubble”

If these policies are not followed, children may be sent home for the group and their own safety.
I have read the above policies and will do my best to support my child to follow them. Signature

Clear

RELEASE, INDEMNIFICATION, AND WAIVER
I, the undersigned, hereby acknowledge that I have been advised and fully understand that certain elements of danger are inherent in the activities sponsored by Human Nature School which are beyond the control of the instructors, agents, officers, students, and employees of Human Nature School, and that participation in any program activities may entail unavoidable risk of personal injury, death, and loss of or damage to property.

These risks include, but are not limited to insect and animal bites and stings, forces of nature such as but not limited to lightning, and unexpected extreme weather conditions, and any hazard present in the wilderness, such as but not limited to low lying branches, sharp objects, and slippery surfaces.

I hereby assume all risks of injury and death to those named above and loss of or damage to property arising out of my participation in such activity and I agree to indemnify, hold harmless Human Nature School, its officers, instructors, volunteers, agents, and employees (“Releasees”) from and against all claims arising from any occurrence causing damage or injury to myself or to any party participating in said event or any third parties injured as a result of my actions.

In case of injury, parents or the emergency contact person will be called immediately for their decision on medical treatment. In the event that parents and/or the emergency contact person is not reachable, I authorize Human Nature School to consent to emergency medical or surgical treatment of the camper and to nonsurgical medical care. Human Nature School will use our best judgment as to what course of action to pursue and will continue to attempt contact.

The camp or our organization will not be responsible for any costs incurred as a result of illness or injury. Parents should notify camp if this camper is exposed to any communicable disease during the three weeks prior to camp attendance.

Campers are asked to leave any valuables and electronics at home. Human Nature School and its employees are not responsible for lost or stolen items.

I Consent to emergency medical and surgical treatment of the camper and minor staff person and to routine, nonsurgical medical care. (If there is religious objection to consenting to receipt of emergency medical or surgical treatment, I must submit a written statement to the effect that the camper is in good health and that the person signing assumes the health responsibility for the camper.)

Prior to signing below, I have read and understand the terms and conditions of this Release, Indemnification, and Waiver, understand by signing below I am waiving certain legal rights I may have against the Releasees, and I agree to subscribe to all the terms and conditions set out above.
Signature

Clear
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Student QUESTIONNAIRE AND WAIVER

Safety Policies for Human Nature School Activities