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Family Night

Registration

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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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Choose the Family Night that you would like to attend
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First Name
Last Name


First Name
Last Name


First Name
Last Name


First Name
Last Name

Medical and liability release

I understand that Experience Learning programs may involve canoeing, hiking, camping, backpacking, stream sampling and other outdoor activities. I understand the inherent risks involved in these activities and that unanticipated dangers may arise. I voluntarily assume all risk of loss, damage, illness or injury, including death, which may occur while I am participating in any activity or event associated with Experience Learning or during such times as I am under the supervision of any employee or agent of Experience Learning. I agree to hold harmless and release Experience Learning and its volunteers, employees, and agents in any location where activities are conducted. If a medical emergency does occur in route to or from or while participating in Experience Learning programs and I cannot readily be reached, Experience Learning may select any licensed physician to secure and administer medical treatment, including hospitalization and surgery for the child if and as needed. I understand any medical expense so incurred will be my financial responsibility. I have listed all the information concerning allergies, medical history or conditions, dietary restrictions and regular medication that I may take.


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Sign here to indicate that you have read the Medical and Liability Release and agree to the terms listed above.
Image use

Experience Learning relies on the use of images of program activities and participant feedback for recruitment purposes, as well as to report to and solicit financial donors. Staff members often take photographs informally throughout a program and these serve as our image library. By signing below you agree that Experience Learning has the right to use pictures or statements by, of, or about you for aforementioned uses.