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.

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

HOUSEHOLD/FAMILY DETAILS:

PARTICIPANT ADDRESS:

* ONLY IF OUTSIDE OF USA

IMPORTANT DETAILS:

Please describe any special dietary restrictions, and indicate whether they result from personal preference, religious custom, or medical necessity.
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 )
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.

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.

YOU MUST CHOOSE ONE OF THESE OPTIONS:
$80.00
TUITION CAP DAY-PROGRAM, Level A 
$50.00
TUITION CAP DAY-PROGRAM, Level B 
$30.00
TUITION CAP DAY-PROGRAM, Level C 
CHECK BOX FOR THIS OPTION:
FEEEQUIPMENT-RENTAL, WATER-SHOES, Weekly 
$5.00

ALMOST DONE, KEEP GOING!