Please submit application form and deposit to:
Cedar Creek Nature Studies
1790 Cedar Creek Rd.
Hot Springs, Arkansas 71901
| There is a $20. Deposit for each 1-day class and a $30. Deposit for each 2-day 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 tracking of plant classes if applicable | ||
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 |