Session *

Choose one or both sessions

Winter 2020

Spring 2020

Parent Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Student's Name *

First Name

Last Name

Students Birthdate *

MM

DD

YYYY

Please confirm understanding by checking all of the following boxes *

I/my child desires to participate voluntarily in an agricultural class activity, and/or other activities sponsored by and/or coordinated at Hidden Savanna Farm (“HSF”).

I understand and acknowledge that the visit to HSF will involve “hands-on” activities such as digging, weeding, harvesting, planting, preparing food, and other activities outdoors such as hiking, building and taking care of farm animals. I understand and acknowledge the risks and dangers involved in these activities to my child, and I know and understand that unanticipated dangers might arise.

Also, we sometimes take pictures or record audio of children on the farm during farm activities. By checking the box, you allow us to use pictures or audio of your child WITHOUT identifying your child by name.

Please confirm understanding by checking boxes below *

Our team has designed a safe, hands-on experience for students visiting the farm. As with any outdoor activity, we must be prepared for injuries or emergencies.

By checking this box, you are releasing Hidden Savanna Farm from legal liability for any injuries that may occur to your child, and you are providing permission for us to seek emergency medical treatment for your child if necessary.

Alternate Emergency Number *

(###)

###

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Alternate Emergency Contact *

First Name

Last Name