Which day(s) are you applying for? *

Rates below per child per 9-week session. Payment due one month prior to each session's start date.

Session 1 - Mondays only ($360)

Session 1 - Tuesdays only ($480)

Session 1 - Mondays and Tuesdays ($840)

Session 2 - Mondays only ($480)

Session 2 - Tuesdays only ($540)

Session 2 - Mondays and Tuesdays ($1,020)

Session 3 - Mondays only ($480)

Session 3 - Tuesdays only ($540)

Session 3 - Mondays and Tuesdays ($1,020)

Session 4 - Mondays only ($480)

Session 4 - Tuesdays only ($540)

Session 4 - Mondays and Tuesdays ($1,020)

Student Information *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Guardian Information *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Guardian #2 Information

(optional)

First Name

Last Name

Phone

(###)

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Emergency Information *

Child's Physician

First Name

Last Name

Physician's Phone Number *

(###)

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Immunization/Health Policy *

Prior to your child’s first day, families must submit a signed Universal Health Form completed by their child’s healthcare provider. This form confirms that your child is in good health and current on required immunizations. Note: At this time, Flu and COVID-19 vaccines are not required for enrollment.

I intend to keep up with my child's routine childhood vaccines and agree to provide a signed Universal Health Form prior to my child's start.

Waiver & Release *

Liability Waiver: I understand that Heartwood Forest School operates classes outdoors and that there are risks which naturally occur whenever children are playing outside. I release Michelle Sawyer, Kristen Unger and Heartwood Forest School from any liability for injuries that might occur as a result of my child attending Heartwood. My child is in good physical health and I will provide appropriate clothing for the weather.

I have read, understand and accept the terms of the liability waiver.

Media Release *

At Heartwood, we love to capture the joy and wonder of forest learning—muddy hands, curious minds, and little moments of discovery. As we build our social presence we'd like to use some of these images on our website, social media, and printed materials to celebrate our nature-based learning community.

✅ I do hereby consent and agree that Heartwood, LLC has the right to take photographs and video clips of my child and to use these on the Educator's websites and promotional materials without compensation. Your child's name and identity will not be revealed.

🚫 No, I do not give permission for my child(ren)’s identifiable images to be used. I understand that Heartwood may still use photos where my child is not identifiable (e.g., backs of heads, hands at play, silhouettes).

Today's Date *

MM

DD

YYYY