Student's First Name(required) Student's Last Name Birthdate City State Zip(required) Total Number in Your Group (If Registering More Than One) 1 2 3 4 5 6 Names and Ages of All Minors Attending Mobile Number (or if student is a minor, parent's number)(required) E-mail Address (or if student is a minor, parent's e-mail address) Emergency Contact Name Emergency Contact Number Does the student have special dietary needs? Yes No If yes, please explain . . . Does the student have any health concerns of which we should be aware? Yes No If so, please explain . . . Courses(required) Bow Making Leather Shoe and Bag Making Wood Arrow and Quiver Making Spring Wild Mushrooming Family Summer Wild Edible Plants in Forest Hill Park Summer Wild Edible Plants in Short Pump Fall 2018 Red Fox Homeschool Program (Ages 8 - 12) Fall 2018 Raccoon Homeschool Program (Ages 4 - 7) Fall 2018 Red Wolf Homeschool Program (Ages 13 - 18) Fridays in the Forest 2018-19 In all courses, events and excursions conducted by Tracks and Roots - its assistant instructors, helpers, and Alison and David Meehan, individually - reasonable care is taken to prevent serious injuries and minimize accidents. The student states that he or she is in good physical and mental health; and fully aware that survival, primitive technology, eating wild plants, and wilderness travel may be dangerous. The student by signing their name below hereby agrees to accept full responsibility for themselves and assume all risks, including those caused by acts of God, injury, death and/or loss to his or her person and/or property. The student hereby waives all present and future rights to make any claims resulting in any way from attending current or future courses, events or excursions conducted by Tracks and Roots, its assistant instructors, helpers, and David and Alison Meehan, individually. Please sign below.(required) Today's Date(required) May we use photos of you taken during the course for advertising purposes? Yes No Coupon Code Does the registrant have any phobias? Is it okay if we share your e-mail address/phone number to the group as part of a class roster? Is your child fully potty-trained, if applicable? Do you have any other special concerns? What do you hope to gain from the course for you or your child? Submit Share this:TweetLike this:Like Loading...
