Registration & consent

Fall Woodland Nature Class

One form per family. The adult signs once for every child listed.

How are you signing?

I am registering a childI am an additional adult attending with a registered child.

Section 1: Family information

Registering more than one child? Use “Add another child” below to add siblings to this form.

Child

Child’s full name *Date of birth *

Name your child likes to be called

Baby in a carrier (if attending): name and date of birthBaby date of birth

Participating adult (the adult who will attend class with the child)

Full name *Relationship to child *Mobile phone *Email (all class updates and cancellations are sent here) *Will a different adult sometimes attend instead? If yes, list name, relationship, and phone. Each of these adults must also complete this form, choosing “I am an additional adult,” before attending.

Parent or legal guardian (if different from the participating adult)

Full namePhoneEmail

Emergency contact (someone not attending class)

Full name *Relationship to child *Phone *

Session

Full series (7 classes) – $175Drop-in – $30 per class (list date or dates)

Each additional child (ages 2 and up) – $15 per class, series or drop-in (applied automatically when you add a sibling)

Registration stays open all season while spots remain. Joining the series after it begins? The series rate is prorated at $25 per remaining class. Drop-ins may register as late as the morning of class if a spot is available. The form and payment must be completed before class begins.

Section 2: Health and safety

Please answer these questions for each child.

Your answers are kept private, shared only with New Heights Learning Center instructors and our website administrator, and used only to keep your child safe.

Child

Does your child have any allergies (including insect stings, plants, foods, or latex)? If yes, describe the reaction and treatment. *Does your child carry emergency medication (such as an epinephrine auto-injector or inhaler)? If yes, it must be brought to every class and kept with the participating adult.Any medical, physical, sensory, developmental, or behavioral needs we should know about to support your child safely?Anything else that helps your child feel comfortable and successful outdoors?

Emergency care

I understand that the participating adult is responsible for their child’s care during class, including giving any medication. In an emergency, I authorize New Heights Learning Center staff to provide basic first aid and to call 911. I understand that I am responsible for any resulting medical costs. *

Sun, insects, and plants

I understand that I am responsible for applying sunscreen and insect repellent to my child before class, and for checking my child for ticks after each class. *

Section 3: Program policies

Please check each box to confirm.

Adult participation required. A participating adult will stay with my child for the full class and is responsible for my child’s supervision, behavior, and safety at all times, including restroom trips, snacks, and transitions. *Siblings. The Class is designed for ages 2–5. Siblings ages 2 and up may join if registered on this form at the sibling rate, and they count toward the 15-child limit. Babies who stay in a carrier for the full class are welcome at no charge and must be listed in Section 1. Other unregistered children may not attend. *Rain or shine. Class meets in rain, heat, and snow. Class may be canceled when weather or other conditions are unsafe. I will check my email before every class for possible cancellations, and I will dress my child for the day’s conditions, including closed-toe shoes. *Follow the guide. My child and I will follow the instructor’s safety directions, stay with the group, and leave plants, mushrooms, berries, and wildlife untouched unless the instructor says otherwise. Nothing found in the woods should go in anyone’s mouth. *Health. I will keep my child home if they are sick or have had a fever in the past 24 hours. *Payment. Registration is complete only after this form is signed and payment is received by Zelle to newheightslearningcenter@gmail.com (memo: child’s name or names and “Nature Class”). Spots are not held until payment is received and are filled in the order payments arrive. If the Class is full, I will be added to a waitlist and contacted if a spot opens. Make-up classes are not offered. If New Heights Learning Center cancels a class, I will receive a refund for that class at the rate I paid. No refunds are given for classes my family misses. *Instructor discretion. New Heights Learning Center may end a class early, change an activity, or ask a family to leave if it believes safety requires it. *

Section 4: Acknowledgment and assumption of risk

PLEASE READ CAREFULLY. Fall Woodland Nature Class (the “Class”) takes place outdoors in a natural, wooded area. Exploring nature is the purpose of the Class, and some risks cannot be removed without changing what makes it valuable. These risks include, but are not limited to:

slips, trips, and falls on uneven, wet, or muddy ground, roots, rocks, and fallen logs
scrapes, cuts, splinters, bruises, sprains, broken bones, and eye injuries from sticks, branches, and other natural materials
bites and stings from insects and other animals, including fire ants, bees, wasps, spiders, mosquitoes, chiggers, and ticks (which can carry disease)
encounters with wildlife, including venomous snakes
contact with poison ivy, thorns, and other irritating or poisonous plants, mushrooms, or berries
allergic reactions, including severe reactions
heat-related illness, cold exposure, sunburn, rain, and quickly changing weather
contact with other children and adults during group play
the distance between the Class site and emergency medical services

Injuries from these risks can be minor, serious, or, in rare cases, life-threatening.

BY SIGNING THIS FORM, I CONFIRM THAT I UNDERSTAND THESE RISKS AND VOLUNTARILY CHOOSE FOR MYSELF AND MY CHILD TO PARTICIPATE. I ACCEPT THESE RISKS ON BEHALF OF MYSELF AND, TO THE FULLEST EXTENT ALLOWED BY LAW, ON BEHALF OF MY CHILD.

I confirm that, to the best of my knowledge, my child and I have no condition that would prevent safe participation, other than what I have shared in Section 2.

Section 5: Release of liability, waiver, and indemnity

THIS SECTION AFFECTS YOUR LEGAL RIGHTS. READ IT CAREFULLY BEFORE SIGNING.

“Released Parties” means New Heights Learning Center LLC, its owners, directors, employees, instructors, and volunteers, and Carrollton Church of the Nazarene, the owner of the property where the Class is held, along with each of their agents and representatives.

1. Release by participating adult. IN EXCHANGE FOR BEING ALLOWED TO PARTICIPATE IN THE CLASS, I RELEASE, WAIVE, AND AGREE NOT TO SUE THE RELEASED PARTIES FOR ANY CLAIM FOR INJURY, ILLNESS, DEATH, OR PROPERTY DAMAGE TO ME ARISING FROM THE CLASS, INCLUDING CLAIMS CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASED PARTIES.

2. Release on behalf of my child. TO THE FULLEST EXTENT ALLOWED BY LAW, I ALSO RELEASE THE RELEASED PARTIES, ON BEHALF OF MY CHILD, FROM ANY CLAIM FOR INJURY, ILLNESS, DEATH, OR PROPERTY DAMAGE ARISING FROM THE CLASS, INCLUDING CLAIMS CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASED PARTIES.

3. Indemnity. I AGREE TO INDEMNIFY, DEFEND, AND HOLD HARMLESS THE RELEASED PARTIES FROM ANY CLAIM, COST, OR EXPENSE, INCLUDING REASONABLE ATTORNEY’S FEES, TO THE EXTENT IT ARISES FROM MY OWN ACTS OR OMISSIONS OR THOSE OF MY CHILD, INCLUDING MY FAILURE TO SUPERVISE MY CHILD, MY OR MY CHILD’S FAILURE TO FOLLOW SAFETY DIRECTIONS, AND ANY INJURY OR DAMAGE MY CHILD CAUSES TO ANOTHER PERSON.

4. What this does not cover. This release and indemnity do not apply to claims caused by the gross negligence or intentional misconduct of the Released Parties.

5. General terms. Throughout this form, “my child” means each child listed on this form. This agreement applies to every Class session I or my child attend, is governed by Texas law, and binds my heirs and legal representatives. If any part is found unenforceable, the rest remains in effect.

I have read Section 5, I understand that I am giving up legal rights, and I agree to it. *

Section 6: Photo and video consent

Photos and video are a regular part of class. New Heights Learning Center uses them to document children’s learning and to share our program with the community. Consent to photos and video is required to participate.

I consent to New Heights Learning Center taking photos and video of my child and me during class, and using them on its website, social media, and printed materials without compensation. My child’s full name will not be shared. *

If you have a safety or privacy concern, please contact us at newheightslearningcenter@gmail.com before registering.

Section 7: Signature

I confirm that I am at least 18 years old, that I am the parent or legal guardian of each child listed (or am signing with their permission and have listed them in Section 1), that the information I have provided is accurate, and that I have read and agree to this entire form. I UNDERSTAND THAT THIS FORM INCLUDES A RELEASE OF LIABILITY AND AN INDEMNITY AGREEMENT.

Typed full name (serves as electronic signature) *Relationship to child or children *Date *

Every adult who attends class must complete this form before participating. Additional adults can sign online in advance or by scanning the QR code at check-in.