REGISTER NOW for BC AOM Staff or Volunteer!

To register for the BC Art of Mentoring STAFF, fill in the form below, click Submit, and then complete payment at the bottom (if applicable for your position only), using the shopping cart. Payment is via Paypal (you can use Paypal to pay with your Paypal account, bank account or credit card). Please use this system if at all possible, to streamline our registration process.
Email ingrid@wisdomoftheearth.ca for alternate payment plans, or if you are having challenges with Paypal.

All prices are in CANADIAN DOLLARS. 5% GST will be added at check-out.

BC Art of Mentoring 2016 STAFF Registration

Welcome to the STAFF registration for the 2016 Art of Mentoring on Salt Spring Island, BC. To complete
registration, please answer these questions and make a payment (if applicable) at the bottom. We look forward to
seeing you at the event!

* = Required

First Name*

Last Name*

Address*

Email*

Age*

Phone Number*

Staff/volunteer position or role you are fulfilling at the BC Art of Mentoring

For Acorn members, youth staff and Village Hearth staff, will you be able to arrive by 4pm on Saturday August 20 (or 10am on Monday August 22, for Site, Beauty and Order Work Trader), and stay until 7pm on Sunday August 28?
If not, please clarify.

Name and age of additional ADULT family member you are paying for (spouse, partner, etc)*
Please write NONE if you coming alone, or if people in your party are registering separately.

Names and ages of Children, Youth or Teens you are registering*
Please write NONE if you aren't registering any children at this event.

Emergency contact name and phone number *

Family Physician name and phone number *

Insurance provider name and policy number *

PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK *

In consideration of the services of Wisdom of the Earth Wilderness School, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf, I hereby agree to release, indemnify, and discharge Wisdom of the Earth Wilderness School, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:

1. I acknowledge that my participation in outdoor adventure based activities climbing, hiking, camping, backpacking, sea kayaking, sailing and fishing entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. Furthermore, Wisdom of the Earth employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather, the elements, or the terrain. They may give inadequate warnings or instructions, and the equipment being used might malfunction.

2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Wisdom of the Earth Wilderness School from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Wisdom of the Earth's equipment or facilities or facilities which they use or rent, including any such claims which allege negligent acts or omissions of Wisdom of the Earth or any persons acting on their behalf.

4. Should Wisdom of the Earth or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.

6. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Wisdom of the Earth on the basis of any claim from which I have released them herein.

I have read and agree to these terms and conditions*

MEDIA RELEASE *

I hereby grant free permission for Wisdom of the Earth Wilderness School to use images of myself and child participating in their programs or events for outreach purposes, including but not limited to photo, audio, and / or video media. Please consider granting this release to us if at all possible, as our ability to successfully share our programs with new participants depends on having representative media. 

YesNo

Medical Questions *

If you have any personal medical conditions or problems that Wisdom of the Earth should be aware of, it is your responsibility to acquaint us with the existing condition both in this form as well as at the registration for the program. All information gathered will be held in confidence and used only to render proper assistance to you should the need arise. You should know that it is possible for participants with a variety of medical/ psychological difficulties to successfully complete our courses, but we must be aware of these conditions for all of our benefit. Failure to disclose such information could result in serious harm to you and your fellow students.

I understand and have read the above*

Do you or anyone in your party have asthma and/or serious allergies? If so, so you have medication or carry an epi-pen? (please explain) *

Do you or anyone in your party have a heart condition?__________If so, please describe your limitiation, medications (if any) and history: *

Do you or anyone in your party have any physical disabilities that may limit participation in this program? If so, please describe disability, limitation, and history: *

Allergies/Intolerance to any insects, plants, foods, medications, etc for everyone in your party. - List below. Please describe your reaction (if you know them) to any of the above. *

List any prescription medications that you or anyone in your party take, the condition prescribed for, the doses and schedules for any such medications, and any known drug reactions. Do you experience any side effects? *

Any mental, emotional or psychological issues we should be aware of at this time for anyone in your party ? All information is kept confidential and is meant to provide a supportive and safe atmosphere for all involved in the program. *

Pertinent medical history *

Dietary Info *

Meals will be mostly organic, with as much local farm fresh produce as possible, as well as wild salmon and carefully sourced chicken and meat. Please put a check mark to any which apply and indicate for how many participants in your family.

Omnivore (eats everything): Yes -

Vegetarian (no fish/chicken/meat): Yes -

Gluten-free: Yes -

Dairy-free: Yes -

Serious allergies (explain):

Additional notes to Wisdom of the Earth staff


Please click the button above to submit your registration information, and then continue to payment below (IF applicable).

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