Forest Bound Application

Name*

First Last

Email*

Please use the email that you would like to use to correspond with coordinators.

Phone*

Age*

Ethnicity*

For grant reporting purposes only

My gender identity:

What city do you live in?*

I currently attend:*

If you currently attend school, what is the name of your school?

I am applying for:*

Please choose the session you are applying for: Sessions are Monday – Friday (9am drop off, 3pm pick up).

Please describe why you would like to be a part of the Forest Bound Program?

Hidden

What are your academic areas of interest?*

Please outline any specific assistance you may need during the program:*

FIELD TRIP RELEASE FORM: Name of participant*

In the space below, please note any health problems and precautions needed (such as unusually severe reaction to bee stings, other severe allergies, hemophilia, diabetes, heart disease etc.):*

The following medication, prescriptions or special diets are needed:*

In the event of an accident or illness, I understand that Forest Bound staff will make a reasonable effort to contact me (the parent) immediately. However, if I am not available, I authorize Forest Bound staff to secure emergency medical care if needed.*

Yes
No

Name of Preferred Doctor & Phone Number:*

Name of Insurance Carrier & Phone Number:*

Primary Contact:*

Best phone number to contact:*

Secondary Contact & Phone Number:

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM*

Forest Bound Participant Name

Photo/video release: the participant / guardian provides consent to have the participant's photo/video taken during the program.

Photos are used on the IAE website, and in other publications/education materials to promote the program. Photos are not used for anything other than Forest Bound materials.

Release of Liability. Please type Name:*

This activity provides a learning experience for the students and allows them an opportunity to apply their classroom learning. Although I understand that the Forest Bound Program will make reasonable effort to provide a safe environment, I am fully aware of the special dangers and risks inherent in participating in the activity. Being aware of those risks, I hereby give consent for the participant listed in this release form to participate in the activity. My signature reflects my knowledge of the details of the trip and the itinerary. I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND /OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, and waive, release and discharge the Institute for Applied Ecology and their directors, board members, officers, employees, volunteers, agents, representatives or assigns and the activity or event sponsors, from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may occur to me as a result of participation in the above named activity at the School Facility. I agree to indemnity, hold harmless, and promise not to sue the entities or persons mentioned above from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of those released or otherwise. This accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.Please have parent read and sign if under 18 years of age.

Intent to E-sign*

I read and agree with the following intent to e-sign:

By checking this box, I agree that this form may be electronically signed, and that my e-signature holds the same validity, enforceability, and admissibility as my handwritten signature.

Parent Signature (if under 18):

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