2018 Wild Child Forest School Fall Programs

Child/Participant

Program(s) *

First Name *

Last Name *

Nickname

Birthday *

Year

Month

Day

Age *

Gender

Female

Male

Primary Parent/Guardian Information

First Name *

Last Name *

Relationship to Child *

Street Address *

City *

Postal Code *

Country *

State/Province *

Phone Number *

Phone Number 2

Email *

Will you be picking up the participant? *

Yes

Secondary Parent/Guardian or Additional Contact Information

We need to have at least 2 individuals on file to ensure that if an emergency does arise, we have a second point of contact. While this information is usually a second parent or guardian, but if that is not appropriate, please provide information for a relative or family friend that we can reach out to, if the Primary Parent/Guardian is not available.

First Name

Last Name

Relationship to Child

Will you be picking up the participant? *

Yes

Share address of

Primary Parent/Guardian Information

Street Address

City

Postal Code

Country

State/Province

Phone Number

Phone Number 2

Participant Information

It is important that staff and volunteers know a little about your child to ensure that they gain the most from their time in this program. All of the information provided will be kept in the strictest confidence.

Signficant Medical Information *

In order to ensure safety of all participants and leaders, please provide any significant medical information about your child. This includes information about known serious allergies, medical conditions, medications, and other physical, behavioural, or mental health information.

Does the child/youth attend child care/school? *

Yes

Which facility?

Will the child/youth know other friends attending the session? *

Yes

If so, please provide names.

Please list what you hope your child will gain from participating in this program

What are your child’s favourite activities?

What can be challenging for you regarding your child’s personality?

What is pleasurable and/or easy for you regarding your child’s personality?

What fears might your child have about nature? (bugs, height, water etc)

If the Forest School is located on public lands used by dog walkers, would this be a concern?

Does your child have a difficult time separating from you and is this a concern for you?

At some locations, we do not have access to indoor bathrooms and may need to answer nature’s call outside. Is this a concern for you?