This form is used to help us learn more about your child, collect emergency contact & medical information and sign agreements. Enrollment Contract: 2024-2025 Parent/Guardian Name * First Name Last Name Child Name * First Name Last Name Child Age * Child Birth Date * MM DD YYYY Sibling Name Please only include Sibling name & age if enrolling. First Name Last Name Sibling Age Sibling Birth Date MM DD YYYY Gender Male Female Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country May we include your child’s name and birthday on our class roster, along with the names, phone numbers and email addresses of the parents/guardians? * Yes No Emergency And Medical Information Emergency Contact Name * First Name Last Name Emergency Contact Phone Number * (###) ### #### Please list other important emergency contacts, their relationship to, best phone numbers or other contact information that will be helpful in an emergency. Also note who else is authorized to pick-up your child from class. * Information About Your Child Describe any developmental conditions that we should be aware of (vision, hearing, speech, movement, cognitive, behavior) * List any food, drug, bee, environmental allergies * List any illness, disability and/or physical limitations our Staff should know about: (If none, enter none) * Does your child tend to wander? * Does your child answer when called? * Current medications or supplements (if any): * Does your child have any fears or worries we should be aware of? * Permission to use sunscreen, bug repellent, or medical cream? * Is there anything else you would like us to know about your child? * Tuition and Cancellation Policy Natural Learning Northwest monthly tuition is $300. Forest School runs September - June (We mostly follow the Tahoma School District calendar.) This program is based on a commitment of one full school year, from September to June. For your convenience, tuition payments are divided into 10 equal installments, payable monthly. Students are considered enrolled for the entire year and budgets and staffing are set accordingly. Early withdrawal creates an opening which Natural Learning Northwest may not be able to fill. If a family must cancel enrollment, monthly tuition must still be paid until the vacancy created is filled by another student. We will make every reasonable attempt to fill vacancies promptly, to minimize any financial hardship on our families. The family is responsible for payment of all scheduled days, regardless of attendance. Payment is due by the 10th of the month. Classes are subject to cancellation if low enrollment. Program rates may increase annually. * Agree Liability Release I understand that Natural Learning Northwest Forest School takes place completely outdoors and that there are risks which naturally occur whenever children are playing outside. I release Colton Running, staff, volunteers, and Natural Learning Northwest, from any liability for injuries that might occur as a result of participating in this program. * Agree Assumption of Risk and Waiver of Liability Relating to Coronavirus/COVID-19 The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Natural Learning Northwest has put in place preventative measures to reduce the spread of COVID-19; however, Natural Learning Northwest cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending Natural Learning Northwest could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Natural Learning Northwest and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Natural Learning Northwest may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Natural Learning Northwest employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at Natural Learning Northwest or participation in Natural Learning Northwest programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Natural Learning Northwest, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Natural Learning Northwest its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Natural Learning Northwest program. * Agree Photo/Video Release I grant to Natural Learning Northwest, its representatives and employees the right to take photographs/video of my child in connection with this program. I authorize Natural Learning Northwest, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Natural Learning Northwest may use such images of my child with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. * Agree Disagree Electronic Signature By entering my name below, I accept the above conditions and releases. (You must be 18 years old or over to sign below.) * First Name Last Name Relationship to registered child. * Todays Date * MM DD YYYY Thank you for enrolling! Please complete the form above to finalize your enrollment for the coming year