Nature Immersion Registration Form (Lump Sum)

Student's Full Name:*

Parent or Gaurdian's Name*

Phone Number*

E-mail Address*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City State ZIP Code

Student's Date of Birth*

Student's Age*

Known Medical Conditions (i.e. allergies, medications, ADD, etc.):*

Emergency Contact Name*

Relationship to Student*

Emergency Phone #*

List names of people authorized to pick up your child:*

How did you hear about us?*

Why are you enrolling your child in Nature Immersion?*

What is your child's experience in nature?*

Social Guidelines Policy*

I have read and agree to the Rewild Portland Social Guidelines Policy

Rewild Portland believes that blanket policies regarding behavior for children of different ages and backgrounds results in lost learning experiences. Instead we use developmentally appropriate guidelines and processes based on the needs of both the group as a whole and individuals in order to maintain social cohesion and safety. Every potential family should download and read our guidelines before enrolling in the program. READ IT HERE

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Nature Immersion Registration Form (Lump Sum)

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