Cedar Creek Nature Studies

Application Form

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There is a $50.00 Deposit for each class. Please Review the Recommended Packing List for Items you may need for your course.
________________________________ ^{Class Name}	____________ ^{Class Date (1st choice)}	____________ ^{Class Date (2nd choice)}
________________________________ ^{Name (Last, First, Initial and or Nickname)}	____________ ^Occupation	____________ ^Age
________________________________ ^{Mailing Address (Number, Street)}	____________ ^Phone	____________ ^{Secondary Phone}
________________________________ ^City	____________ ^State	____________ ^{Zip Code}
________________________________ ^{Contact in case of Emergency}	____________ ^Phone	____________ ^Relationship
___________________________________________________________________ ^{Medical history that may be relevant in the event of an emergency}
___________________________________________________________________ ^{Special Dietary Needs (i.e. Vegetarian, Diabetic, etc.)}
___________________________________________________________________ ^{Please List any previous CCNS tracking or plant classes if applicable}

WAIVER AND RELEASE:

During all classes, demonstrations and excursions conducted by the Cedar Creek Nature Studies, reasonable care is always taken to prevent serious injuries and to minimize the risk of accidents.The Student listed above states that he/she is fully aware that survival, tracking, awareness and philosophy training, even under the safest possible conditions may be dangerous.The Student hereby agrees to accept full responsibility and assume all risks including those caused by Acts of God, injury, death, and/or loss of his/her person and/or property knowingly and voluntarily.The Student certifies that he/she is physically capable of participating in the indicated classes as listed above.

My signature below indicates my acceptance of these terms and my desire to participate in Cedar Creek Nature Studies. I am also aware that my deposit is non-refundable if I should fail to notify Cedar Creek Nature Studies of my cancellation within at least 48 hours prior to the first day of class.

_________________________
^{Applicant's Signature}

__________
^Date

Please submit application form and deposit to:

Cedar Creek Nature Studies
1790 Cedar Creek RD
Hot Springs, AR 71901

"Those who contemplate the beauty of the earth find reserves of strength that will endure as long as life lasts."
~ Rachel Carson ~

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