Bushcrafting With Ryan Adult Enrollment – Bell Creek Nature School

Name *

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Last

Current Address *

Address Line 1

Address Line 2

City

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Workshop - Check all that apply: *

PNW Wild Plant Identification Basics: June 12th, 10:00AM-2:00PM
Friction Fire Basics: July 10th, 10:00AM-3:00PM
Handmade Spoon Carving: August 7th, 10:00AM-2:30PM

Sliding Price Model

Please indicate what price you are willing to pay for each workshop:

Amount Selected: $45

Contact/Medical Information

Partipant 1: *

Name and Mailing Address

Home Phone Number (guardian 1)

Cell Phone Number (guardian 1) (copy)

Email Address (guardian 1)

PLEASE LIST AT LEAST TWO PEOPLE WHO CAN BE CONTACTED IN CASE OF AN EMERGENCY. A CONTACT PERSON SHOULD BE SOMEONE WHO IS READILY AVAILABLE.

Name #1

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Name #2

Phone

FAMILY DOCTOR

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MEDICAL INSURANCE

Policy Holder

Policy Number

Group Number

Medications you are allergic to (if none, please write 'none'):

Medications you are currently taking (if none, please write 'none'):

Allergies (if none, please write 'none'):

If you have a medical condition, such as asthma, please describe (if none, please write 'none'):

MEDICAL EMERGENCY AUTHORIZATION

I may not be available to provide consent for medical treatment in the event that I become sick or injured during participation in a Bell Creek Nature School authorized activity. If I am not available for such consent, it is my desire to have the best available medical treatment. This form hereby authorizes Bell Creek Nature School LLC and its staff to act on my behalf with respect to any required medical treatment decisions and consents until such time as I am able to provide these items. In the event that I cannot be reached in an emergency, I hereby give my permission to call 911 and/or contact a medical facility or physician selected by the school staff to secure proper treatment. Notice is hereby given to any qualified medical personnel that this authorization is currently in effect and such personnel are directed to act upon such authorization without delay. I agree to assume financial responsibility for all expenses and bills incurred in any emergency requiring medical attention.

MEDICAL EMERGENCY AUTHORIZATION I/We may not be available to provide consent for medical treatment in the event that our child becomes sick or is injured during participation in a school authorized activity. If I/we are not available for such consent, it is my/our desire to have the best available medical treatment for my/our child. This form hereby authorizes Bell Creek Nature School LLC and its staff to act on our behalf with respect to any required medical treatment decisions and consents until such time as I/we are able to provide these items. In the event that I cannot be reached in an emergency, I hereby give my permission to call 911 and/or contact a medical facility or physician selected by the school staff to secure proper treatment for my child. Notice is hereby given to any qualified medical personnel that this authorization is currently in effect and such personnel are directed to act upon such authorization without delay. I/We agree to assume financial responsibility for all expenses and bill incurred in any emergency requiring medical attention. *

Date

LIABILITY WAIVER

I understand that Bell Creek Nature School takes place outdoors, and that there are risks which naturally occur outside. I release Ryan Johnson, Bell Creek Nature School, and Bell Creek Nature School staff from any liability for injuries that might occur as a result of participating in Bell Creek Nature School Programs. I am in good physical health and I will provide appropriate clothing for the weather.

LIABILITY WAIVER I understand that Bell Creek Nature School takes place outdoors, and that there are risks which naturally occur whenever children are playing outside. I release Bell Creek Nature School, and Bell Creek Nature School staff from any liability for injuries that might occur as a result of participating in Bell Creek Nature School Programs. My child is in good physical health and I will provide appropriate clothing for the weather. *

Date

ENROLLMENT CONTRACT

Participant's Name *

Please read the following information carefully. This application is subject to the following conditions:

THE PARTICIPANT NAMED ABOVE IS FINANCIALLY RESPONSIBLE FOR TUITION PAYMENT OF THIS COURSE. PAYMENTS WILL BE MADE TO RYAN JOHNSON VIA CASH, CHECK, OR ELECTRONIC SERVICES SUCH AS PAYPAL OR VENMO PRIOR TO THE CLASS STARTING DATE.

Contract Signature *

I have read and agree to the terms above.

Participant's Signature *

Date

Notice of Nondiscriminatory Policy as to Students: Bell Creek Nature School admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, sexual orientation, or national and ethnic origin.

Phone

BUSHCRAFTING WITH RYAN ENROLLMENT

Summer 2021

Sliding Price Model

Contact/Medical Information

MEDICAL EMERGENCY AUTHORIZATION

LIABILITY WAIVER

ENROLLMENT CONTRACT