Community Event: Whitewater Paddling: Deerfield River Fife Brook Session 1
September 18, 2021
7:00 AM - 7:00 PM
AGES: 8 yrs and older
Open to all Kroka students and their families.
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TRANSLATE THIS FORM: Español, Português, Tiếng Việt, Tagalog, Kreyòl ayisyen
FOR WHOM?
I WILL PARTICIPATE
I AM A PARENT OR GUARDIAN
REGISTERING A NEW CHILD/MINOR TO PARTICIPATE
I AM A RETURNING PARENT OR GUARDIAN:
OUR FAMILY or HOUSEHOLD HAS REGISTERED FOR OTHER PROGRAM ACTIVITIES WITHIN THE PAST 3 YEARS
YOUR (PARENT/GUARDIAN) NAME:
YOUR (PARENT/GUARDIAN) CONTACT INFORMATION:
NAME:
(not parent)
CONTACT INFORMATION:
(OPTIONAL)
BIRTHDATE:
Please enter a valid birthdate here...
GENDER:
Please enter a gender information here...
use button or write in anything!
Male
Female
Non-Binary
PRONOUNS:
use button or write in anything!
He/Him/His
She/Her/Hers
They/Them/Theirs
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HOUSEHOLD/FAMILY DETAILS:
PARTICIPANT MAILING ADDRESS:
* ONLY IF OUTSIDE OF USA
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IMPORTANT DETAILS:
DIET:
NONE
Please describe any special dietary restrictions, and indicate whether they result from personal preference, religious custom, or medical necessity.
ALLERGIES:
NONE
Any ALLERGIES?
To foods? To medications? To insect stings or other environmental agents?
If so, please explain the symptoms and the severity of these allergies: ( MILD DISCOMFORT or SEVERE LIFE THREATENING ANAPHYLAXIS )
MEDICATIONS:
NONE
Any regular MEDICATIONS? If so, please list the medications, their dosage and frequency, and their purpose. This information may be used to administer medications during a program, but more importantly it will help medical professionals in the event of an emergency.
CONCERNS:
NONE
Tell us any concerns you may have about participation in our programs: Any
injuries or physical limitations
, or any
emotional, behavioral, or mental health issues
, any
sleep issues
,
substance abuse
, history of
infections
, or anything else that you can let us know in advance to help our staff to make the program safe and enjoyable for everyone.
Please note: failure to disclose significant medical or learning issues undermines our work and the safety of our programs, and we reserve the right to dismiss any participant who arrives with undisclosed conditions.
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YOU MUST CHOOSE ONE OF THESE OPTIONS:
$35.00
TUITION CAP DAY-PROGRAM, Per Child
$50.00
TUITION CAP DAY-PROGRAM, Per Person
$175.00
TUITION CAP WEEKEND-PROGRAM, Overnight
CHECK BOX FOR THIS OPTION:
FEE
EQUIPMENT-RENTAL, WATER-SHOES, Weekly
$5.00
SHOPPING CART
ADJUST QUANTITIES:
ITEM
QUANTITY
SUBTOTAL
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ALMOST DONE, KEEP GOING!
PLEASE COMPLETE THIS VALIDATION:
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