AWI STUDENT Confirmation Form 2020

Parent Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

PHONE NUMBER *

Name of Participant 1 *

First

Last

Birthday of Participant 1 *

Age of participant 1 *

Grade level in Fall 2020 *

Name of participant 2 *

First

Last

Age of participant 2 *

Birthday of Participant 2 *

Grade level in Fall 2020 *

Name of Participant 3 *

First

Last

House for participant 3 *

Name of Participant 4 *

Birthday of Participant 4 *

Age of Participant 4 *

Any Health concerns, allergies or medical Conditions? *

This year at Art and Wilderness Institute, we are building school spirit and teaching that our actions affect people we may never even meet. To do this, we have developed "HOUSES" (Kind of like Harry Potter's Hogwarts Academy.) Please have your children take this fun and easy test to see what House they belong to and then select the house they got.

Grade Level in Fall 2020 *

Which class is your child enrolled in? (Select all that apply) *

Homeschool Mondays Mentorship Program Tues- San Dimas Co-op Thurs- Noura's Naturalist 101 Class Thurs- Noura's Nature Explorer Class 1st - 3rd Thurs- Nishat's Eco-Defenders Class Fri- Megan's Nature JOurnaling and plant medicine class Fri- Farah's 6th and 7th grade science Fri- Farah's KG class

House for participant 4 *

By signing below, I verify I have read and agree to the Art and Wilderness Institute Payment Policy *

By signing below, I verify that I have read and agree to the Liability and Media Release Waiver. *

By signing this Waiver, I assume all risk of my child and/or myself participating in all classes that are between the duration of June 24th, 2020 through July 30, 2021. Without signing this form, neither myself nor my child will be able to participate in the Art and Wilderness Institute’s program(s). I acknowledge that these activities may pose some risk of personal injury and that I undertake and assume this risk for myself and my child. On behalf of myself and my child, I further waive and release the promoters of the activity, school facility, any insuring entity of the above, and their directors, board members, officers, employees, volunteers, agents, representatives, or assigns, as well as the activity sponsors, from any and all liability, including, but not limited to, liability arising from negligence or fault of the entities or persons for any injury or disability which may occur as a result of my or my child’s participation in the above activity. I am assuming all risks on behalf of myself and my child that may arise from negligence or carelessness on the part of any of the persons or entities being released, as well as from defective equipment, real property or personal property that is owned, maintained or controlled by the above persons. The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Art and Wilderness Institute (“AWI”) has put in place preventative measures to reduce the spread of COVID-19; however, AWI cannot guarantee that you or your child(ren)will not become infected with COVID-19. Further, attending AWI could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, Iacknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I maybe exposed to or infected by COVID-19 by attending AWI and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at AWI may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families. I CERTIFY THAT MY CHILD AND MYSELF ARE PHYSICALLY FIT AND SUFFICIENTLY PREPARED FOR PARTICIPATION IN ALL AWI CLASSES ENROLLED IN AND THAT THERE ARE NO HEALTH RELATED REASONS OR PROBLEMS WHICH WOULD PRECLUDE THE PARTICIPATION OF MYSELF OR MY CHILD IN THE ACTIVITIES. I HAVE NOT BEEN ADVISED OF ANY REASON WHICH WOULD LIMIT MY CHILD OR MYSELF IN PARTICIPATING IN THE ACTIVITIES. I consent to receive any medical treatment deemed advisable for an injury to myself or my child during the activity and that any medical or other insurance for myself and/or my child will be insurance of first resort before contribution by any other insurance for any other person or entity, including accidental death and dismemberment insurance and accident medical insurance. I understand that I and/or my child may be photographed while participating in the activity. I agree to allow my and my child’s photo, video, or film likeness to be used for any legitimate purpose by the activity holders, sponsors, producers, and their assigns. I shall defend, hold harmless, and indemnify the parties from and against all losses, claims, damages, costs or expenses (including reasonable legal fees, or similar costs) in connection with any action or claim brought or made (or threatened to be brought or made), for, or on account of any injuries or damages, received or sustained by myself and/or my child arising during the course of the Activity. This Agreement constitutes the sole and only agreement between the parties concerning my child’s and my release and indemnification as a condition for participating in this activity. Any prior agreements, whether oral or in writing, shall be void and of no further effect. This Agreement may not be modified. I certify that I have read this document, and I fully understand its contents. I am aware that this is a release and indemnification of liability for myself and my child, and I sign it of my own free will.

Upload Hand-Signed Liability Waiver *

Max file size: 20MB

Emergency Contact Person *

Emergency Contact Phone Number *

I plan on paying through: *

Other: Charter/Out of pocket combo *

Would you be interested in being on the PTA of Art and Wilderness Institute? *

We have a few clubs that are run by students with an advisor that your child can sign up for. The cost to join the club is only $20 for the school year. All fees and club dues will go to support club activities and projects. If you wish to support any of these clubs, please paypal info@artandwildernessinstitute and note the club that you are supporting. 100% of funds will go into student run projects.

Please check any you are interested in and we will reach out to you for more info.

Extra-Curricular Club INTEREST *

Journalism Team Nature Allies Club Nature Poetry Club None

Choose Any *

Yes! Please add me to the mailing list!

YOUR CART

AWI
2020- 2021
STUDENT CONFIRMATION FORM

STEP 1- YOUR INFORMATION

STEP 2- YOUR CHILD'S INFORMATION

STEP 3- WAIVERS & EMERGENCY INFO

DOWNLOAD, SIGN and then UPLOAD this LIABILITY WAIVER

STEP 4- PAYMENT and POLICIES

STEP 5- MISCELLANEOUS

YOUR CART

AWI2020- 2021STUDENT CONFIRMATION FORM

STEP 1- YOUR INFORMATION

STEP 2- YOUR CHILD'S INFORMATION

STEP 3- WAIVERS & EMERGENCY INFO

DOWNLOAD, SIGN and then UPLOAD this LIABILITY WAIVER

STEP 4- PAYMENT and POLICIES

STEP 5- MISCELLANEOUS

AWI
2020- 2021
STUDENT CONFIRMATION FORM