Environmental Learning for Kids

Please Fill out the Form to Enroll in ELK!

 

Address*
City *
State*
Postal Code*
Guardian's Email*
Guardian's Confirm Email*
Home Phone
Student's Cell Phone
Student's Email
Birthday
Race(s)/ Ethnicity(s)
  • African American
  • Caucasian
  • Asian/Pacific Islander
  • American Indian/Alaskan Native
  • Hispanic/Latino
  • Other
School
School District
Active Status (Check Active)*
  • Active
Participation Type (Check Youth)*
  • Youth

Parent(s)/ Guardian(s) Information

Guardian(s) Name(s)*
Guardian's Cellphone
Guardian's Work Number
Best way to Contact Guardian
  • Text
  • Phone Call
  • E-mail
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact #
Alternate Emergency Contact Name
Alternative Emergency Contact #
Alternate Emergency Contact Relationship
How did you hear about ELK?
  • School/Library Program
  • Booth at a Special Event
  • Teacher or School Administrator
  • Friend
  • Family Member
  • ELK Blog
  • Facebook
  • Newspaper
  • ELK Website
  • Radio
  • Other
  • Board Member
  • Fundraising Event
  • Staff Member

Health History

Name of Insurance Company
Policy #
Policy Holder's Name
Name of Insured
Doctor's Name
Doctors Phone #
Health History- Check and provide information for any condition that student has or is subject to:
  • Asthma
  • Fainting Spells
  • Convulsions
  • Swim/Sport Restrictions
  • Diabetes
  • Heart Trouble
  • Allergies
  • Reaction to Medication
  • Other
Please specify nature of any condition(s) or medication(s):
Please specify any allergies:
Are there any restrictions to any activity for medical reasons?

RELEASE FROM RESPONSIBILITY, ASSUMPTION OF RISK AND WAIVER

RELEASE FROM RESPONSIBILITY, ASSUMPTION OF RISK AND WAIVER

In consideration of my being permitted by ELK to participate in any program activities;

I (parent/guardian from student named above), the undersigned exercising my own free choice to allow my child’s participation voluntarily in program activities and promising to take due care during such participation, hereby release and discharge, indemnify and hold harmless ELK and their members, officers, agents, employees, and any other persons or entities acting in their behalf, and the successors and assigns for any and all of the aforementioned persons and entities, against all claims, demands, and causes of action whatsoever, either in law or equity, relating to injury, disability, death or other harm, to person or property of both, arising from my child’s participation in and/or presence at any activity. 

I acknowledge that Environmental Learning for Kids (ELK) conducts field trips and programs that take place in the outdoors, and I am fully aware of the inherent risks to my child that are associated with the outdoors, including, but not limited to exposure to the elements (i.e. sun, wind, rain, snow), risks associated with falls, uneven trails, bug bites, poison ivy, bee stings, and potential interaction with other plants and wild animals. 

I understand that this is not a comprehensive list of all of the risks to my child. I acknowledge that I have been informed of hazards and risks, which may be associated with my child’s participation in program activities: I understand, accept, and assume those hazards and risks, and waive all claims against ELK and other persons set forth above. I understand that I am solely responsible for any costs arising out of any bodily injury or property damage sustained through participation in normal or unusual acts associated with program activities.

Parent/Guardian of student named above (hereinafter called "the student"), a participant in ELK, hereby affirm that,

WHEREAS, the activity will be organized and sponsored by ELK and the student or volunteer will, during such time, be actual physical custody of representatives of ELK who will be in charge of the event; and

WHEREAS,I also desire to release and indemnify ELK and its representative from and against all liabilityassociated with the event.

NOW, THEREFORE, I do hereby declare and authorize the following;

1. ELK staff, board, and volunteers are hereby declared to be my attorneys-in-fact empowered to, and specifically authorized to, arrange and authorize any medical care or treatment for the student during the above specified times of the activity which shall, in the discretion of such representatives, be necessary. I hereby accept full responsibility and pledge to pay the entire cost of any such medical care or treatment for the student or volunteer. Third parties may rely upon these statements.

2. I do further hereby release fully ELK, its directors, officers, employees, and agents, from any loss liability that shall arise in any manner by virtue of the student's participation in the event. This release is given both on behalf of the student or volunteer and on behalf of myself/ourselves individually.  The student or volunteer, by her or his signature herein below, and to the extent he or she has legal capacity to do so, also hereby releases fully ELK, its directors, officers, employees and agents from any loss or liability that shall arise in any manner by virtue of the students or volunteers participation in the event.

3. I do further agree to fully defend and indemnify ELK, its directors,officers, employees and agents from and against any loss or liability that shall arise in a manner by virtue or the students or volunteers participation in the event. 

I hereby grant permission to ELK to disseminate through broadcasting or publishing, pictures, and/or voice recordings taken during any ELK activities in which the student, parent, or volunteer appears.

I have had sufficient time to review and seek explanation of the provisions contained above, have carefully read them, understand them fully, and agree to be bound by them.  After careful deliberation, I voluntarily give my consent and agree to this release, Assumption of Risk, and WAIVER. 

 
Waiver*
  • Yes; I fully enter into and agree to the above Release from Responsibility, Assumption of Risk, and Waiver
Date (MM/DD/YYYY)*

Let us know...

Would you like to receive information about upcoming ELK events for youth and families?*
  • Yes
  • No
Would you like to receive ELK's monthly e-newsletter?*
  • Yes
  • No

Personal Conduct Agreement

It is the purpose of the Personal Conduct Agreement to set standards and guidelines for
students participating in any and all of Environmental Learning for Kids programs
including Denver Youth Naturally. The standards set forth in this agreement are in place
to provide an atmosphere that is conductive to individual growth and experiential learning. If any of the
below listed behaviors are displayed, disciplinary action may be taken. Discipline may include, but
is not limited to, being sent home, loss of privileges, removal from the group, or release from the
program. The disciplinary action will match the offense in a constructive manner and a change in behavior will
be expected. We are committed to helping every student successfully complete the program. This is important
to us and we expect the same commitment from every student.

Please read the following behaviors to demonstrate understanding of inappropriate behavior: 

  • Inappropriate sexual behavior and/or harassment
  • Engaging in verbal abuse (name calling, ethnic or racial slurs, or derogatory statements or vulgar or obscene gestures) directed towards any individual or group of students or volunteers
  • Promoting and/or involvement in gang or gang-like activity
  • Possession of a dangerous weapon in accordance with the State Law
  • Wearing of clothing that displays vulgar or offensive language, ethnic or racial slurs
  • Use of alcohol, illegal drugs, or tobacco products of any kind (also covers abuse of non-prescription drugs)
  • Bullying or threatening behavior towards fellow participants, volunteers or staff (include all physical abuse)
  • Theft of any kind
  • Endangering your life or the lives of others
  • Not following the guidelines for any of the activities
Personal Conduct Agreement*
  • I understand and accept the following conditions for participating in Environmental Learning for Kids and the Denver Youth Naturally Program.
Date*
Additional Comments

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