Be sure to have the time to complete this form in its entirety. You will NOT have the option to save and continue at a later date. This form may take approximately 20 minutes to complete. To make completing this form easier, have these references in front of you: doctor office contact info, insurance info, your child's health history, and your emergency contact's info.

Input your first child's info below.

Please fill out the health background for your first child below.

This health history is correct and accurately reflects the health status of the child to whom it pertains. The person described has permission to participate in all program activities except as noted by me and/or an examining physician. I give permission to the physician selected by The Nature Institute to order x-rays, routine tests, and treatment related to the health of my child for both routine health care and in emergency situations. If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the information on this form will be shared on a "need to know" basis with education staff. I give permission to photocopy this form. In addition, The Nature Institute has permission to obtain a copy of my child's health record from providers who treat my child and these providers may talk with the program's staff about my child's health status.

If for religious or other reasons you cannot sign this, contact The Nature Institute for a legal waiver which must be signed for attendance.

Please complete the questions below relating to those persons who have your permission to pick up your child from The Nature Institute Program. Please provide any additional information necessary in the space provided.

Both parents are approved for pick up unless otherwise noted.

Dear parent/guardian, please review the rules and behavior policy before your child attends the program. Please sign once you review the info below.

1. Appropriate clothing must be worn at all times. Closed-toed shoes required on hikes. NO SANDALS, PLEASE! Children may bring sandals to wear when changing clothes after water activities to go home in. Please no swimsuits or clothing that do not fit properly. Parents will be called and asked to bring appropriate clothing for child if need be.

2. Three Strikes and You Are Out Rule will apply to misbehavior. Educators will note the first offense with a verbal warning on the warning sheet. After the second warning, the child will be asked to sign the warning sheet that will be given to a parent/guardian and put in the Education Director's file. After the third warning, child will be asked to sign the sheet again and parents/guardians will be called to take child home. The rule applies to, but is not limited to, the following; Violence towards an educator or another child, swearing, disrespect to an educator, leaving assigned group without educator's permission, talking or misbehaving during guest speaker programs, stealing, use of alcohol or illegal drugs, and bullying.

1. No running on or around porch 2. No running inside lodge 3. No sitting on the deck railing 4. No climbing on or through deck railing 5. All participants must be with assigned group at all times. 6. Please put games, toys, supplies and others away after each use. 7. All trash and recyclables should be picked up and disposed of in trashcans or recycling bins. 8. Only three people at a time in borrow and eagle's nest.

The Nature Institute must ask for permission from you, the parent or guardian, on a few issues regarding TNI policies.

During programs we have opportunities that may have your child's photo taken during activities. The photographs will only be used for promotions and marketing for The Nature Institute on brochures, our website and other social media, reports, etc. We appreciate you taking the time to sign this permission agreement so that we can comply with privacy laws and ethics. If your signature does not appear below, we will assume you do not want your child's photograph to be used.

Your child's leader will assist with applying sunscreen to bare surfaces including the face, tops of ears and bare shoulders, arms, legs, and feet 15-30 minutes before outdoor activities. Sunscreen will not be applied to any broken skin or if a skin reaction has been observed.