Through The Trees

Shinrin Yoku Registration

 
Shinrin Yoku Registration


Program Information

*

Participant Information



Date of Birth*: (mm/dd/yyyy)






School & Grade*:


Medical Information

By providing thorough medical information about your child, Through The Trees staff and families work together to provide a safe and nurturing environment for all children.

Medical Information*:

Dietary Restrictions*:

Additional Information:


Emergency Contact Information

Name*:
Relationship*:
Address*:
Email*:
Phone Number*:
Work Number:


Name:
Relationship:
Address:
Email:
Phone Number:
Work Number:


Payment Information

Through The Trees can work with families and individuals to create a payment plan that works for you.
Please note there is a $5 service charge for paying cash or check.

Preferred Payment Method*:


Waiver Statement

I give TTT Staff permission to take pictures, video, and other forms of likeness of me/my child for use in media, marketing, and other forms of dissemination. As a Through The Trees (TTT) participant, I have informed the TTT Staff of any medical needs I may have and give the Staff permission to administer basic first aid and prescription medicines as needed and directed. While I am participating in any TTT activity, I take full responsibility for any physical injuries or conditions that I may have at this time or have had in the past and I relinquish the rights to sue. Through The Trees, its Staff, and associated people will not be held liable for any injuries, illnesses, or damages that may occur during the course of these programs or events or during transportation to and from events and/or locations.
By checking the box, you agree to all the conditions in the above Waiver Statement*:

How did you hear about Through The Trees?



Additional payment information is on the next page!