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Family Wilderness Skills Weekend | November 6-8, 2020
Participant Information & Release of Liability
*
Indicates required field
Parent/Guardian #1 Name
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First
Last
Parent/Guardian #2 Name
*
First
Last
Teen/Youth #1 Name
*
Teen/Youth #1 Age
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Teen/Youth #2 Name
*
Teen/Youth #2 Age
*
Teen/Youth #3 Name
*
Teen/Youth #3 Age
*
Teen/Youth #4 Name
*
Teen/Youth #4 Age
*
Teen/Youth #5 Name
*
Teen/Youth #5 Age
*
Teen/Youth #6 Name
*
Teen/Youth #6 Age
*
Please list any allergies, food or otherwise, as well as dietary restrictions we should be aware of. If there are none for any member of your family, please write 'none'.
*
Please list any medical conditions and/or medications we should be aware of. If there are none for any member of your family, please write 'none'.
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Is there anything else we whould know?
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Have you been to the Primitive Camp before?
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Yes
No
How will your family get into camp?
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Drive 4x4 vehicle (returning families)
Meet at Wells Mills and follow 4E Staff (requires 4WD/AWD)
Shuttle ride from 4E Staff (contact Jamie@4eee.org!) *
* IMPORTANT: If you will park a vehicle at Wells Mills Park and get a ride into the Primitive Camp from 4E Staff, please provide the Make/Model/License details for the vehicle that will be parked overnight Friday and Saturday.
Vehicle Make
*
Vehicle Model
*
License Plate #
*
RELEASE OF LIABILITY.
I understand that attendance and participation in this event may involve risk of injury or death from various hazards, both obvious and obscure, including but not limited to: injury by other group participants, falling, being struck by falling objects, weather exposure and other risks or occurrences not set forth in this agreement. By typing my name as digital signature and submitting this form, I accept and assume responsibility for all persons listed on this form for any and all such risks, whether or not specifically itemized herein. I acknowledge that 4 Elements Earth Education (“4E”), its employees, event staff, volunteers, board members, property owners, family of the same, and any organization that 4E represents or contracts with shall be held harmless and blameless in the event of such an aforementioned mishap. In consideration of participating in this family event and adventures with 4E, I — on my behalf and on behalf of my heirs, assigns, and representatives — do hereby irrevocably release 4E, its employees, staff, volunteers, board members, property owners, family of the same, and associated organizations from any and all claims which involve any nature of injury or death or damage to persons or property that may occur as a result of attendance or participation by anyone listed on this form.
Typed Name as Digital Signature for Release of Liability
*
Please let us know if you have any questions or concerns in advance of this event. We look forward to seeing you on November 6th!
4 Elements Earth Education | www.4eee.org | 530-265-2036 | info@4eee.org
Submit!
Home
Programs
Fox Walkers Youth Programs (CA)
Coyote Tracks Youth Programs (PA)
Online Youth Programs
Teens & Families
Scholarships
About
About Our Team
Teaching Philosophy
Board of Directors
Videos
Directions and Map
Join Our Team
FAQS
Support
Give Now
Volunteer
Contact
Blog
Store