| Participant's Name: | Parent(s) Name(s): |
| Address: | Date of Birth |
| Age | Gender |
| Phone h/w | Email: |
List any
medical conditions such as allergies, asthma, reactions to bee stings, reactions
to medicine:
Please list family
(child's) physician and phone number:
|
Session One: For ages 7 - 9 |
|
|
SEEDS Passport to ecology and nature |
| Pardon me salamander, can you please quiet down, I'm listening for raptors! 23 - 27 June, Fee is $220.00 |
|
SEEDS Florida Trip |
Session Two: For ages 10-12 |
| Mountains to the Valleys - SEEDS Passport to ecology and nature 21 - 25 July, Fee is $220.00 |
| The SEEDS Adventure-nauts 28 July – 1 August, Fee is $220.00 |
| PLEASE INDICATE ABOVE WHICH PROGRAM(S) YOU ARE SIGNING UP FOR: |
WAIVER:
1. In consideration of the acceptance of my application for entry in the above event or class, I hereby waive, release and
discharge any and all claims for damages for death, personal injury or property damage which I may have as a result of above named participation. This release is intended to discharge in advance SEEDS and Odiero, Ltd. and its agents, board, volunteers, and employees from and against any and all liability arising out of or connected in any way with my participation in said event or class, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above.
2. I understand that serious accidents occasionally occur during outdoor activities, or indoor activities, and that participants occasionally sustain mortal or serious personal injuries, and/or property damage, as a consequence thereof. Knowing the risks of the particular activity for which the above signed is registered, I hereby agree to assume those risks and to release and hold harmless all of the persons or entities mentioned above who (through negligence or carelessness) might otherwise be liable to me (or my heirs or assigns) for damages.
3. It is further understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns.
4. I give SEEDS and Odiero, Ltd. the right to use photographs of the above signed, participating in this program, in its own promotional and news
materials.
5. I and/or the above signed agree to accept and abide by the rules, regulations, and ethics of SEEDS.
6. List above any medical problems such as allergies, asthma, allergic reactions to bee stings, etc.
It is
likewise assumed that said participant will wear the proper clothing and
protective equipment during said program (see list below) and that it is the
responsibility of the parent or guardian to make sure this criteria is met. I
grant my permission to transport said participant to and from said event when
required and hold harmless those assigned to transport. I also agree to allow
transportation of said participant to the nearest physician or hospital for
medical treatment and agree to allow for immediate first aid to the injured said
participant when deemed necessary.
Parent or Guardian has read and understands the following two statements:
YOUR CHILD WILL BE INVOLVED WITH SUPERVISED PHYSICAL ACTIVITY and may run, jump, swing, and climb trees. If you do not want your child doing certain kinds of activities, please inform us in writing and we will ask your child to refrain from said activity.
YOUR CHILD MAY COME INTO CONTACT WITH OTHER LIVING CREATURES. Bee stings, scratches from plants, and rashes as a result of contact with plants are possible. We will teach your child to identify plants like poison ivy, but they still might touch it!
A DEPOSIT OF
50% is required with registration. Mail to: SEEDS PO Box 824 Blacksburg VA
24063
(Balance due on the first day of each program that you register
for.)
* If you are interested in FINANCIAL AID, please contact SEEDS.
*
If you are interested in making a donation to the SEEDS scholarship fund please
contact SEEDS. You will be helping somebody to participate who couldn't
otherwise! Your donations are tax deductible under Section 501(c)(3) of the
Internal Revenue Code.
* If you or somebody you know has a child who would enjoy the field camps and needs financial aid, please contact SEEDS.
Parent
or Guardian Name
(print):_______________________________________________________
Parent or Guardiean SIGNATURE:_____________________________Date:______________________
| Light Knapsack | Water Shoes/Sneaks | Towel | Sun Block |
| Bag Lunch & Snacks | Water Bottle | Rain Coat | Change of Clothes |