Parent/Guardian Name
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First Name
Last Name
Email
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Phone
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(###)
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Which experience are you registering for?
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Name(s) of Child(ren) attending
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First Name
Last Name
Child's Birthday
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MM
DD
YYYY
Primary Contact Phone Number
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(###)
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How did you hear about TimberNook
Other Adults Authorized to Pick Up Child
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If yes, please list below
Please tell us something about your child (hobbies, interests, personality, etc.)
Does your child have:
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Please explain any health or developmental issues checked above
Does your child use an inhaler or take any medication?
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Please indicate specific medication and dosage
Please list any ALLERGIES your child has, and indicate severity of allergies (specific reaction to allergen, use of api-pen, etc.)
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Is there any other condition that we should be aware of that may endanger, alter, or somehow limit your child's abilities to participate in any nature program?
Please describe:
Is your child current with their immunizations?
Consent for medical treatment:
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In the event that I cannot be reached in an emergency requiring medical attention for the above named child or children, permission is hereby given for the staff of TimberNook programming whom are CPR/first aide certified to administer CPR and/or first aide as deemed necessary. Further permission is given to allow medical services to be performed by doctors, hospitals, or other qualified medical providers as deemed necessary in an emergency, including surgery if reasonably necessary. I understand that the cost of all emergency services is my responsibility.
Sunscreen and Bugspray
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TimberNook will re-apply sunscreen and bug spray products throughout the day as needed. Parents should supply these products for their child.
Photo Release
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Occasionally, photos and video will be taken during programming and may be used for TimberNook publications including its website and Facebook page. However, we will not identify your child by name or release any personal information.
Affirmation of Terms & Conditions, Privacy Policy, and Liability Release
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TimberNook Legal Terms & Conditions
By registering for any TimberNook program, the registrant acknowledges that they have read, understand and agree to the following:
CONSENT FOR MEDICAL TREATMENT
In the event that a parent or guardian cannot be reached in an emergency requiring medical attention, permission is hereby given for the staff of TimberNook programming whom are CPR/first aid certified to administer CPR and/or first aid as deemed necessary. Further permission is given to allow medical services to be performed by doctors, hospitals or other qualified medical providers as deemed necessary in an emergency, including surgery if reasonably necessary. I understand that the cost of all emergency services is my responsibility.
PHOTO RELEASE
Occasionally, photos and video-taping will be taken during programming and may be used for TimberNook publications including its Website and facebook page. However, we will not identify you or your child by name or release any personal information.
LIABILITY RELEASE WAIVER AND AUTHORIZATION
Participation at a TimberNook location exposes participants to certain risks of being in the outdoors. Accidents and injuries resulting from the forces of mother nature, live animal and bug interactions, slipping and falling, malfunctioning equipment, unseen obstacles, fatigue, illness (including exposure to and infection with viruses or bacteria), and your own and others’ misjudgment are very real possibilities. I further acknowledge that the preceding list is not inclusive of all possible risks associated with TimberNook program participation.
AFFIRMATION AND LIABILITY RELEASE
1. I hereby affirm that I have been informed that there are inherent dangers of being outdoors at a nature program.2. I hereby agree to indemnify and hold harmless this TimberNook provider and its owners, volunteers, and workers as well as TimberNook, LLC from any and all liability for any harm, injury, death, or damages (physical, mental, or monetary), regardless of fault or negligence, which may befall me and/or my child while participating in this program or while using TimberNook facilities. This release shall be binding upon my family, heirs, and administrators.3. I hereby agree to heed at all times the advice and instructions of the TimberNook provider and its owners to practice common sense while at the nature program.4. The participant, a minor child has permission to participate in the activities of TimberNook programming.I acknowledge that if anyone is hurt or property is damaged during my or my child’s participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against the TimberNook provider and TimberNook, LLC on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read the TimberNook Legal Terms & Conditions in its entirety. I have read & understood it, and I agree to be bound by its terms.
POLICY
TimberNook does not discriminate in any way on the basis of age, sex, gender, race, color, marital status, familial status, physical or mental disability, and/or religion or national origin.
FINANCIAL TERMS
TimberNook is not responsible for cancellations or refunds. By signing up for a program, you are agreeing to your specific TimberNook location & provider’s individualized refund and cancellation policy.
We (TimberNook) are committed to protecting and respecting your (“you” “the user’s” “our customer’s”) privacy.
We take your privacy seriously and will only use your personal data to provide you the information, products, and/or services you have requested from our company. This Privacy Policy does not apply to websites or third parties linked to this site. We recommend you review the policies of other parties you choose to interact with.
Information We May Collect
During your interaction with our website, we may collect the following information: Internet Protocol (IP) Address, browser type and version, time and date of visit, and/or operating system. With your consent, we may collect: first name, last name, email address, physical address information, shipping address information and phone number. Additionally, we may request voluntary information that pertains to a specific product or service offered by or through the website such as: sizing information, dates, resumes, cover letters, image uploads, etc. Please do not share any information that you are not comfortable sharing. We may also collect information used to create your online account (such as username, password and security question and answer.)
Why We Collect This Information and How We Use It
The information described above is collected for different reasons:1. To provide a smooth, customized experience regardless of the device used to access our website.2. To answer questions about products or services.3. To sign up or register users for events.4. To conduct e-commerce.5. To monitor analytic data, website traffic, devices used and regional information for marketing and advertising purposes.
How Long We Keep Information
We securely keep information as long as it is necessary to execute a user’s request. Thereafter we keep the information indefinitely unless/until it is requested to be removed by the user.
How Can My Information Be Removed?
The information collected from you can be removed from our system at your written request via the contact information found on this website.
What are Cookies?
Cookies are small data files that are placed on your computer or mobile device when you visit a website. Cookies are widely used by website owners in order to make their websites work more efficiently, as well as to provide reporting information.
Why Do We Use Cookies?
We use cookies for several reasons. Some cookies are required for the technical support of our website operation, and we refer to these as “essential” or “strictly necessary” cookies. Other cookies also enable us to track and target the interests of our users to enhance their experience on our website.
How can I Control Cookies?
You have the right to decide whether to accept or reject cookies using your Web browser preferences. For essential cookies, you can set or amend your web browser controls to accept or refuse cookies. If you choose to reject essential cookies, you may still use our website though website functionality may be affected. Cookie management can vary, visit your browser’s help menu for more information.
Changes to Our Privacy Policy
This Privacy Policy may be updated periodically and without prior notice to you to reflect changes in our information practices. Check this page periodically for potential updates.
Participation at a TimberNook location exposes participants to certain risks of being in the outdoors. Accidents and injuries resulting from the forces of mother nature, live animal and bug interactions, slipping and falling, malfunctioning equipment, unseen obstacles, fatigue, and your own and others' misjudgment are very real possibilities.
THE UNDERSIGNED CERTIFY THAT THEY AGREE AS FOLLOWS: 1. I hereby affirm that I have been informed that there are inherent dangers of being outdoors at a nature program. 2. While all program participants are consistently well supervised, accidents do happen. The undersigned(s) assume(s) all risk of injury or harm to the child associated with participation in the program and agree(s) to release, indemnify, defend and forever discharge TimberNook and it's staff, employees, and agents of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action in respect of death, injury, loss or damage to the child, or by the child, howsoever caused, arising or to arise by reason of or during the child's participation in the program. 3. 1 hereby agree to heed at all times the advice and instructions of the TimberNook and its owners to practice common sense while at this program. 4. The above-named participant, a minor child has permission to participate in the activities of TimberNook programming.
Please enter the date signed
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MM
DD
YYYY
Please enter your full name below to sign this Agreement electronically
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