Participant's Name *

First Name

Last Name

Parent/guardian's name *

First Name

Last Name

Most useful phone numbers *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Emergency Contact Cell Phone Number *

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Emergency Contact Home Number

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Emergency Contact Work Number

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Family Physician Name

First Name

Last Name

Phone Number of Family Physician

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Participant/Parent/Guardian Consent and Agreement *

We, the undersigned participant, and parent or guardian of the child named on this application, acknowledge that we are fully aware that certain elements of danger are inherent in the activities sponsored by Teen Forest Adventures, which are beyond the control of the agents, the landowners and staff/employees of Teen Forest Adventures, and that participation in any program activities may entail unavoidable risk of personal injury, exposure to viruses or infectious pathogens, death, and loss of or damage to property. We are aware of the types of activities in which the child will be participating during his/her stay and have been given ample opportunity to ask any questions which we may have about the environment the child will be in and the activities he/she will participate in. We are aware of the dangers that are inherent in the operation of any outdoor program and in the participation in all program activities on or off premises of said program including, but not limited to, hiking, athletics, including bodily contact, use of tools and equipment, backpacking, outdoor-living skills, and vehicular travel. We understand that this is an all-outdoor program, and are aware that participants will remain outdoors regardless of weather conditions.

I have read and understood the terms and conditions of this agreement/waiver and we agree to subscribe to them.

Participant/Parent/Guardian Medical Authorizations *

The Health History I have provided, whether via the registration form or otherwise, is complete and accurate to the best of my knowledge, and the person therein described has permission to engage in all program activities except for those noted on the online form or otherwise indicated in writing to Teen Forest Adventures. I hereby give permission to Teen Forest Adventures to provide routine health care, administer prescribed medications, and seek emergency medical treatment including ordering x-­‐rays or routine tests. I agree to the release of any records necessary for insurance purposes. I give permission to Teen Forest Adventures to arrange necessary related transportation for me/my child. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by Teen Forest Adventures to secure and administer treatment, including hospitalization, for the person named above.

I have read the statement above and agree to these medical authorizations.

Benadryl for Anaphylaxis *

The nature of our programs, being outdoors and off-trail, dictates that participants may encounter allergens that they've yet to be exposed to in their life (such as a bee or wasp sting, for example). Thus, in rare cases, there is the potential of unknowingly triggering an allergic reaction in a child that could escalate and lead to anaphylaxis. Anaphylaxis is a serious, potentially life-threatening allergic response that is marked by swelling, hives, lowered blood pressure, and dilated blood vessels. In severe cases, a person will go into shock. If anaphylactic shock isn't treated immediately, it can be fatal. The most common and effective means of preventing an allergic reaction from escalating to anaphylactic shock is to quickly administer a dose of an antihistamine. During any of our programs, if a child exhibits signs and symptoms of an allergic reaction that continues to escalate and begins resembling anaphylaxis, our policy is to immediately administer an appropriately portioned dose of an antihistamine such as Benadryl, or other brand of diphenhydramine.

I have read the statement above and agree to the use of Benadryl for anaphylaxis for my child as needed.