Name:

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Age:

E-Mial Address:

Street:

City:

State:   Zip:

Country:

Phone:
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(Area Code & Number)

Secondary Phone:
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(Area Code & Number)

Class Name:

1 Animal Tracking Man Tracking I Man Tracking II WE&M Plant Walk Wild Edible Plants Medicinal Plants Soap Making Flute Making Awareness I Awareness II Primitive Skills Fire Making Pipe Making

2 None Animal Tracking Man Tracking I Man Tracking II WE&M Plant Walk Wild Edible Plants Medicinal Plants Soap Making Flute Making Pipe Making Awareness I Awareness II Primitive Skills Fire Making Primitive Cooking

Class Date: (1st choice)

Class Date: (2nd Choice)

Previous Classes through CCNS if applicable:

Special Dietary Needs:

Medical History relevant in the case of an emergency:

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.

Date: (mm/dd/yy)

Clicking the Submit button verify's that you have read and agree to the Waiver and Release of CCNS.