WOLF Kids 2017 Registration

To register for WOLF Kids for Sept 2017, please FILL IN the form below and CLICK SUBMIT. This form is for RETURNING STUDENTS, and new families who have received CONFIRMATION of acceptance into the program.

TO COMPLETE REGISTRATION: If you have not already done so, please SEND your NON-REFUNDABLE DEPOSIT of $300 ASAP. You can send an etransfer to info@wisdomoftheearth.ca OR leave a cheque made out to “Wisdom of the Earth” in the Wisdom of the Earth envelope in the community files at Apple Photo in Ganges.

NOTE:  All sections of the registration form must be filled in to submit successfully. Please write NONE or N/A if the section does not apply to you.

WOLF Kids 2017 Registration

Please fill in the form and click Submit.

* = Required

Student's Name*

Birthdate*

Parent #1 Name*

Street Address and Postal Code*

Email*

Home Phone Number*

Cell Phone Number*

Parent #2: Please provide NAME, PHONE NUMBER(S) and EMAIL of second custodial parent, if applicable.

Additional Emergency Contact name and phone number *

Family Physician name and phone number *

Medical Care Card Number*

Are you registering with any Distributed Learning Program? If so, which one? (ie, Heartwood, Learning Design Partners, SelfDesign etc)

MEDIA RELEASE *

I hereby grant free permission for Wisdom of the Earth Wilderness School to use images of my child and myself 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

Does your child have asthma and/or any serious allergies to any insects, plants, foods, medications, etc ? If so, does s/he have medication or carry an epi-pen? (please explain) *

Does your child have any physical conditions that may limit or impact participation in this program? If so, please describe, including any medications we should be aware of: *

Any mental, emotional, psychological or family issues we should be aware of? All information is kept confidential (may be shared with relevant staff) and is meant to provide a supportive and safe atmosphere for all involved in the program. *

May your child be given non-aspirin pain relievers such as tylenol or ibuprofen?*

In the event of an emergency situation where parents cannot be contacted, do you authorize the staff at the WOLF program to obtain, through a physician of their choice, medical care that may become reasonably necessary?*

Additional comments or notes to WOLF Kids staff

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