Wind Dance Home School Registration 2024-25

Wind Dance

Farm and Earth Education Center

Embracing the Earth

Home School Enrollment

Enrollment is OPEN for Program Year 2024-25

*New to Wind Dance? Please call to schedule a visit before enrolling:

304-258-0558*

Child's Name

Birthday and Age in September

Address

Day(s) of Attendance

Monday & Wednesday (2 days a week) ~Wilderness Wanderers (ages 4-7)

Monday OR Wednesday (1 day a week)-Wilderness Wanderers (ages 4-7)

Monday~ Young Explorers (ages 9-12)

Tuesday ~Hiking Tikes (ages 3-4)

Tuesday-Explorers (ages 12-14)

Wednesday ~Young Explorers (ages 7-8)

Wednesday-Explorers (ages 12-14)

Friday~ Young Explorers & Explorers (Optional Second Day)

Are you a current homeschooling family or planning to homeschool your child beyond the preschool years?

Yes, we homeschool or plan to homeschool beyond the preschool years.

No, we do not homeschool and are not plannning to homeschool beyond the preschool years.

Is Your Child a WV Hope Scholarship Recipient or in the process of becoming a WV Hope Scholarship Recipient?

Yes

Parent/Guardian #1

Phone

Parent/Guardian #2

Phone number

Email address

Emergency Contact

Emergency Contact Phone #

Medical Information

Health Insurance Provider

Policy Number

Insurance Provider Phone

Primary Physician

Physician Phone

Permissions

Do you give permission to administer homeopathic remedies to your child?

Yes

Do you give permission to use photos for articles, social media and website?

Yes

Dietary Restrictions

Vegetarian

Vegan

Gluten Free

None

Other (please list below)

Please describe/list any allergies, chronic illness, disabilities, medical conditions or general concerns that Wind Dance Staff should be aware of:

Please share any additional information that you think we should know about your child/family

Transportation

Daily transportation to and from Wind Dance Farm for homeschool and other programs is solely the responsibility of the parent/guardian of the student. While families may choose to share rides with other families or Wind Dance staff, Wind Dance Farm is in no way liable for accidents or injuries that occur in transit to and from Wind Dance Farm. I give the following people permission to pick-up my child from Wind Dance Farm:
(Please list name(s) and relationship.

Waiver and Release Form for Educational Programs
With the understanding that Wind Dance Farm & Earth Education Center will make every reasonable effort to prevent accidents, injuries or other mishaps, I agree to release and hold harmless Wind Dance Farm & Earth Education Center, its officers, agents, employees, and volunteers for any and all claims, demands, costs, and expenses, including reasonable attorney’s fees that Wind Dance Farm & Earth Education Center may suffer as a result of any claim, action, demand, or judgment against it arising from the attendance of educational programs by this applicant and/or family members.This release is intended to discharge in advance Wind Dance Farm & Earth Education Center, its officers, employees, agents, and volunteers from liability. It is understood that some program activities involve an element of risk of accidents, and at times participants will be transported from Wind Dance Farm & Earth Education Center to another location, and knowing the risks, I hereby assume those risks. Additionally, it is understood that during the ongoing COVID-19 pandemic, attending group activities may carry a risk of exposure to the COVID-19 virus, despite precautions undertaken in advance of and during time at Wind Dance Farm & Earth Education Center. Wearing of masks is optional. It is further understood and agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assignees. I agree to release Wind Dance Farm & Earth Education Center from any and all liabilities.
Parental Consent
I give consent for my child to participate in the above activities, and I execute the above liability release on their behalf.
Consent for Treatment
I hereby give my consent to have the above applicant treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in the above activity. It is understood that Wind Dance Farm & Earth Education Center will provide no medical insurance for such treatment and that the cost there of will be at my expense.

Wind. Dance reserves the right to decline admission for any reason deemed appropriate by the Board of Directors.

Wind Dance reserves the right to terminate program attendance at any time for any reason deemed appropriate by its Board of Directors.

I have read and understood the foregoing liability release and parental consent form and agree to all of its terms and conditions.

Signature

Date

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