Outdoor Education Enrollment Packet

OUTDOOR EDUCATION ENROLLMENT PACKET

Program Name:    Session Dates: From to

STUDENT INFORMATION

Date of Birth:    Student ID:    Grade/Program Level:

Primary Phone:    Alternate Phone:

PARENT/GUARDIAN INFORMATION (IF STUDENT IS A MINOR)

Relationship:    Phone:    Email:

EMERGENCY CONTACTS

Relationship:    Phone:

Relationship:    Phone:

MEDICAL INFORMATION & AUTHORIZATIONS

Physician Phone:    Health Insurance Provider:

Asthma    Diabetes    Seizure Disorder    Cardiac Condition    Mobility Limitation

I authorize program staff to administer the medications listed above in accordance with medication administration instructions and to obtain emergency medical treatment if necessary.
Consent to medication administration: Yes    No

PROGRAM FEES, PAYMENT AND CANCELLATION

Tuition Amount: $    Deposit Required: $

Pay in Full    Installment Plan (refer to program for schedule)

Cancellation and Refund Policy: Tuition and deposit are subject to program cancellation and refund provisions. Participant acknowledges that fees may be forfeited for cancellations made within a defined period prior to program start, and that partial refunds are at the sole discretion of program administration based on incurred costs.

TRANSPORTATION

Participants may be transported by program-authorized vehicles for program activities and emergency transport. By checking below, the undersigned grants permission for such transportation.
I consent to transportation by program staff and authorized carriers.

PHOTO / MEDIA RELEASE

Photographs, video, and audio recordings may be made during program activities for educational, promotional, and archival purposes. The undersigned grants the program permission to use such media without compensation, unless expressly revoked in writing prior to program start.
I accept the photo/media release    I decline the photo/media release

CODE OF CONDUCT AND PARTICIPANT RESPONSIBILITIES

Participants are expected to follow staff instructions, respect other participants, and comply with site rules. Prohibited behaviors include endangering self or others, possession of illegal substances, and refusal to follow safety protocols. Program staff reserve the right to remove any participant for serious or repeated violations; removal may be without refund.

I have reviewed the Code of Conduct and accept responsibility to comply with program rules.
Acknowledged

LIABILITY WAIVER, ASSUMPTION OF RISK & INDEMNITY

In consideration of participation in the outdoor education program, the undersigned acknowledges that participation involves inherent risks, including but not limited to: travel, terrain hazards, weather conditions, water-related activities, wildlife encounters, and physical exertion. The undersigned voluntarily assumes all such risks and agrees that the program, its employees, volunteers, agents, and affiliates shall not be liable for personal injury, property damage, or wrongful death arising out of participation, except to the extent caused by the program's gross negligence or willful misconduct.

The undersigned agrees to indemnify and hold harmless the program and its representatives from any claims, demands, losses, or expenses (including reasonable attorneys' fees) arising out of the undersigned's participation or breach of this agreement.

EMERGENCY MEDICAL AUTHORIZATION

If emergency medical treatment is required and the undersigned or the authorized emergency contact cannot be reached, I hereby authorize program staff to arrange for medical care and to secure necessary treatment including transportation to a medical facility. I understand that every reasonable effort will be made to contact the emergency contacts provided prior to non-life-threatening interventions.
I authorize such emergency treatment: Yes    No

PRIVACY, RELEASE OF RECORDS & SPECIAL ACCOMMODATIONS

Participant health information provided on this form will be used only for program administration and emergency care and will be shared only with staff, medical personnel, or others as necessary for the participant's safety. By signing, I authorize the release of relevant medical records and information to program staff and emergency service personnel if necessary.

ADDITIONAL AUTHORIZATIONS AND ACKNOWLEDGMENTS

By signing below, I certify that the information provided on this enrollment packet is true and complete to the best of my knowledge. I understand and accept the program policies, tuition and refund provisions, the Code of Conduct, the Liability Waiver, and I consent to emergency medical treatment as described above. I agree that this document shall be binding upon my heirs and legal representatives.

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