KROKA EXPEDITIONS

Wilderness Adventures for Homeschoolers

September 7 - December 14, 2022

AGES: 10 - 14

Homeschoolers

TRANSLATE THIS FORM: Español, Português, Tiếng Việt, Tagalog, Kreyòl ayisyen

FOR WHOM?

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:

CONTACT INFORMATION:

BIRTHDATE:

Please enter a valid birthdate here...

GENDER:

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

BACK

HOUSEHOLD/FAMILY DETAILS:

PARTICIPANT MAILING ADDRESS:

YOU MAY ENTER ONE OR TWO RELATED ADULTS
WHO LIVE or WORK AT THIS ADDRESS:

ADULT #1

(optional)

parent, step-parent, guardian, spouse, etc.

(optional)

ADULT #2

(optional)

parent, step-parent,
guardian, spouse, etc.

(optional)

I WANT TO INCLUDE ANOTHER ADULT/PARENT/GUARDIAN AT A DIFFERENT ADDRESS

SUBMIT ADULT CONTACT INFORMATION

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PERSONAL INTRODUCTION

What specifically interests you in this program?
What other interests / hobbies / activities do you enjoy?

What specifically interests your child in this program?
What other interests / hobbies / activities do they currently enjoy?

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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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Tuition deposit is due with registration. Additional materials and equipment fees (+/- $150) not included in tuition. Please contact us about financial aid availability.

$1,500.00

TUITION CAP HOMESCHOOL, Level A
Household Annual Income of $185,000 or more ($100/day)

$1,275.00

TUITION CAP HOMESCHOOL, Level B
Household Annual Income of $100,000 - $185,000 ($85/day)

$975.00

TUITION CAP HOMESCHOOL, Level C
Household Annual Income of $70,000 - $99,000 ($65/day)

$750.00

TUITION CAP HOMESCHOOL, Level D
Household Annual Income of $50,000 - $69,000 ($50/day)

$600.00

TUITION CAP HOMESCHOOL, Level E
Household Annual Income of $30,000 - $49,000 ($40/day)

$525.00

TUITION CAP HOMESCHOOL, Level F
Household Annual Income up to $29,000 ($35/day)

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STUDENT PARTICIPATION QUESTIONS

STUDENT QUESTIONS FOR PARTICIPATION IN KROKA PROGRAMS

Dear Kroka Student,

We are so excited to see you this summer at Kroka for an expedition or adventure on the farm! In order to help your Kroka instructors get to know you and to be sure that you are in the best program for you please answer the following questions in your own words. You may type your answers in the box below. Or better yet! Hand-write your answers, then scan or take a picture of the paper and upload your answers to the form.

Please feel free to tell us anything additional you would like your Kroka teachers to know about you. You may also attach photographs, artwork, poetry, creative writing, etc! If you want to call us and sing a song that is welcome as well.

FOR STUDENTS AGES 9-12:

1. Why do you want to come (or return) to Kroka and why did you choose this program?
2. What do you like to do outdoors?
3. Tell us about something you did this year that you are proud of?

FOR STUDENTS AGES 13-18:

1. Why are you choosing to come (or return) to Kroka?
2. During the past year, what have been your favorite activities outside of school? What is it you like about them?
3. At different times on your program you may be hot, cold, tired, hungry, bothered by bugs and frustrated with other people. Please describe how this will be for you, and how you might act at those times.
4. We live as a family here at Kroka. You will be responsible for helping with chores, caring for your belongings and living respectfully within the group, many times putting the groups’ needs before your own. Please write about a time when you have had to do this before. How did it feel?

CLICK HERE TO UPLOAD YOUR IMAGE or DOCUMENT

SUBMIT THIS SECTION

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ALMOST DONE, KEEP GOING!

BACK

FOR WHOM?

HOUSEHOLD/FAMILY DETAILS:

PERSONAL INTRODUCTION

TELL US ABOUT YOURSELF:

TELL US ABOUT YOUR CHILD:

IMPORTANT DETAILS:

ALMOST DONE, KEEP GOING!

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