Sustainability Adventure
Sun Jul 10 - Sat Jul 23, 2022 (14 days)
AGES: 15 - 18

TRANSLATE THIS FORM: Español, Português, Tiếng Việt, Tagalog, Kreyòl ayisyen

FOR WHOM?

I WILL PARTICIPATE
I AM A PARENT OR GUARDIAN
REGISTERING A NEW CHILD/MINOR TO PARTICIPATE
I AM A RETURNING PARENT OR GUARDIAN:
OUR FAMILY or HOUSEHOLD HAS REGISTERED FOR OTHER PROGRAM ACTIVITIES WITHIN THE PAST 3 YEARS

HOUSEHOLD/FAMILY DETAILS:

PARTICIPANT MAILING ADDRESS:

* ONLY IF OUTSIDE OF USA
YOU MAY ENTER ONE OR TWO RELATED ADULTS
WHO LIVE or WORK AT THIS ADDRESS:
(optional)
(optional)

(optional)
(optional)
I WANT TO INCLUDE ANOTHER ADULT/PARENT/GUARDIAN AT A DIFFERENT ADDRESS
SUBMIT ADULT CONTACT INFORMATION

PERSONAL INTRODUCTION

What specifically interests you in this program?
What other interests / hobbies / activities do you enjoy?
What specifically interests your child in this program?
What other interests / hobbies / activities do they currently enjoy?

IMPORTANT DETAILS:

Please describe any special dietary restrictions, and indicate whether they result from personal preference, religious custom, or medical necessity.
Any ALLERGIES?
To foods? To medications? To insect stings or other environmental agents?
If so, please explain the symptoms and the severity of these allergies: ( MILD DISCOMFORT or SEVERE LIFE THREATENING ANAPHYLAXIS )
Any regular MEDICATIONS? If so, please list the medications, their dosage and frequency, and their purpose. This information may be used to administer medications during a program, but more importantly it will help medical professionals in the event of an emergency.

Tell us any concerns you may have about participation in our programs: Any injuries or physical limitations, or any emotional, behavioral, or mental health issues, any sleep issues, substance abuse, history of infections, or anything else that you can let us know in advance to help our staff to make the program safe and enjoyable for everyone.Please note: failure to disclose significant medical or learning issues undermines our work and the safety of our programs, and we reserve the right to dismiss any participant who arrives with undisclosed conditions.

YOU MUST CHOOSE ONE OF THESE OPTIONS:
$3,705.00
TUITION SUMMER TWO-WEEK, Level A 
Household Annual Income of $185,000 or more
$3,135.00
TUITION SUMMER TWO-WEEK, Level B 
Household Annual Income of $100,000 - $185,000
$2,755.00
TUITION SUMMER TWO-WEEK, Level C 
Household Annual Income of $70,000 - $99,000
$2,185.00
TUITION SUMMER TWO-WEEK, Level D 
Household Annual Income of $50,000 - $69,000
$1,615.00
TUITION SUMMER TWO-WEEK, Level E 
Household Annual Income of $30,000 - $49,000
$1,330.00
TUITION SUMMER TWO-WEEK, Level F 
Household Annual Income up to $29,000
CLICK TO CHOOSE ANY OF THESE OPTIONS:
FEEEQUIPMENT-RENTAL, MOUNTAIN-BIKE, Weekly 
$250.00
FEEEQUIPMENT-RENTAL, RAIN-COAT, Weekly 
$20.00
FEEEQUIPMENT-RENTAL, RAIN-PANTS, Weekly 
$20.00
FEEEQUIPMENT-RENTAL, RUBBER-BOOT, Weekly 
$5.00
FEEEQUIPMENT-RENTAL, SLEEPING-BAG, Weekly 
$25.00
FEEEQUIPMENT-RENTAL, SLEEPING-PAD, Weekly 
$5.00
FEEEQUIPMENT-RENTAL, WATER-SHOES, Weekly 
$5.00

NEXT
PARENT AGREEMENT FOR SUMMER REGISTRATION
YOU'RE ALMOST DONE WITH THE REGISTRATION FORM... BUT BEFORE YOU GO ANY FURTHER:

We need to make sure you understand our admissions policies. Because of the unique and challenging nature of our summer programs, we take extra care in the registration process and may not admit every child. Before accepting any student, we strive to ensure that:

  • The student has genuine interest in the program and is excited to come
  • The student is physically fit enough to participate in all aspects of the program
  • The family shares a mutual understanding of our unique philosophy and approach to programming

Once you complete the registration process, someone from our office may give you a call to get to know you further and help ensure Kroka will be a good fit for your family. Before you complete this form, please confirm that:


1) You have read and understand our Parent/Student Handbook (this has been developed over the years to try to give you a complete picture of what to expect while at Kroka and how to prepare for the experience

2) The student is personally excited to come to Kroka and is choosing this experience


We look forward to seeing you next summer!


I have read and understand the above and I am ready to move forward with the registration process / YES | NO
YES
NO
SUBMIT THIS SECTION
AGREEMENT & ASSUMPTION OF RISK FORM

PARENT OR PARTICIPANT AGREEMENT

Dear Kroka Expeditions Parent(s)/Guardian(s) and/or Adult Program Participants,

*** PLEASE NOTE, PARTICIPANTS WHO WILL BE 18 YEARS OR OLDER MUST PERSONALLY SIGN  THIS  AGREEMENT FORM***

Our work would not be possible without a covenant of trust between you (the parents and guardians of our students), and us (the staff and teachers at Kroka Expeditions). By enrolling your child in this program, you will be asking us to care for their personal physical and emotional needs, while at the same time creating a safe, nurturing student community and providing fun and appropriate challenges and adventures on the farm and in the wilderness. During the program your child will be living outside, walking barefoot, working with sharp tools and fire, climbing tall rocks and trees, jumping into streams, paddling and swimming in fast moving rivers, carrying heavy loads over uneven ground, and living in the elements – all with the possibility of getting overheated or cold, sun-burned, or soaking wet, and much more. It is our job as teachers and guides to be well prepared to do all we can to protect and take care of all our students. Thus we work year-round to scout the terrain and weather, purchase and maintain the highest quality of safety and adventure equipment, to plan, prepare, and pack nourishing delicious meals, and constantly update our emergency medical training and technical outdoor skills.

In return we ask for your trust and cooperation as our most important partners in this work. By signing this agreement you acknowledge that:

  1. If you are a parent, you give permission for your child to participate in this program, and have been informed about the planned activities and the potential risks involved. You also accept that planned program activities and itineraries may change without notice based upon the needs of the group and the changing weather and environment
  2. you are confirming here that you have carefully read and understood the Kroka Handbook, (available on our website) and you believe that you or your child can take the age-appropriate level of responsibility to care for themself while at Kroka
  3. you have accurately completed Kroka’s medical information and emergency contact information forms, and that you or your child have no undisclosed medical or emotional problems or limitations which might affect their ability to participate in this program
  4. you authorize Kroka staff to give routine or emergency medical care if needed, within the limits of common sense and established wilderness medical protocols. If urgent care is necessary, you give permission for Kroka to seek professional help and/or or transport your child to a medical facility. You agree to pay all costs associated with that care and transportation
  5. you agree to be responsible for the repair or replacement of any items that are lost or damaged under your child’s care and use
  6. you give Kroka Expeditions permission to use any photographs or audio/video recordings of you or your child, taken during participation in Kroka programs, for any publicity or promotional materials, both online and in print. (Note: Kroka respects your privacy, and will never publicly publish, trade, or share your (or your child’s) name, address or contact information. However, often students make new friends at Kroka, and ask us to share the names and addresses of students within their specific program so that they can keep in touch with one another, which we are happy to do. Please let us know if you have any concerns or reservations about this.
  7. you understand that Kroka reserves the right to dismiss any student from the program that staff believes, in their discretion, presents a safety concern or medical risk, is disruptive, or otherwise deliberately conducts themself in a manner detrimental to the program. Use of illegal drugs, marijuana, tobacco products, alcohol, intimate relationships, sexual or other forms of harassment, sexual activity or socially exclusionary behavior, or disregarding clear instructions are examples of conduct that Kroka considers detrimental to the program, and that can lead to early dismissal. If your child is dismissed or departs for any reason, you accept responsibility for all costs of early departure whether for medical reasons, dismissal, personal emergencies or otherwise.
PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK
.
In consideration of the services of Kroka Expeditions Inc., their agents, owners, officers, volunteers, employees, and all other persons or
entities acting in any capacity on their behalf (hereinafter collectively referred to as " KE "), I hereby agree to release, indemnify, and
discharge KE, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:

1. I acknowledge that my participation in Guided Rock Climbing and Guided River Rafting activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: loss or damage to equipment being used; being lost or separated from guides or companions; the hazards of walking on uneven terrain; being struck by rock fall, icefall or other objects dislodged or thrown from above; the use of climbing ropes and equipment; falling objects; collision with fixed or movable objects; weather conditions; water hazards; accidental drowning; whitewater rapids will be encountered; being jolted, jarred, bounce, and shaken about; exhaustion; rafts or boats capsize; exposure to temperature and weather extremes which could cause cold water shock, hypothermia, hyperthermia (heat related illnesses), heat exhaustion, sunburn, dehydration; and exposure to potentially dangerous wild animals, insect bites, and hazardous plant life; pinches, scrapes, twists and jolts, sprains, strains, scratches, bruises, abrasions, cuts, lacerations, broken bones, fractures, musculoskeletal injuries including head, neck, and back injuries; wrist, arm, or shoulder injuries; or even more severe life threatening hazards; equipment failure; and improper lifting or carrying; transmissible pathogens or diseases; my own physical condition, and the physical exertion associated with this activity; accidents or illness can occur in remote places without medical facilities and emergency treatment or other services rendered; consumption of food or drink; Foreign countries have their own laws and standards of acceptable conduct; food and water related illnesses; foreign political, legal, social, transportation, health, and economic conditions; different standards of design, safety, and maintenance of buildings, public places, and conveyances; local & medical facilities and providers; weather conditions; criminal activity, environmental hazards; standards of living and health standards that are not equivalent to life in the United States.

2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My or my child's participation in this activity is purely voluntary, and we elect to participate in spite of the risks. Additionally, I and/or my child agree to wear a U.S. Coast Guard approved personal flotation device (life jacket) while participating in all water activities and a certified helmet for all climbing activities.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless KE from any and all claims, demands, or causes of action, which are in any way connected with my or my child's participation in this activity or my use of KE 's equipment or facilities, including any such claims which allege negligent acts or omissions of KE.

4. Should KE or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

5. I certify that I have adequate insurance to cover any injury or damage I or my child may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition that I or my child may have.

6. In the event that I file a lawsuit against KE, I agree to do so solely in the state of New Hampshire and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect. By signing this document, I acknowledge that if anyone is hurt or property is damaged during participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against KE on the basis of any claim from which I have released them herein. I also agree that this document is valid for subsequent visits and participation at KE. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Electronic Signature Authorization

By entering my name below, I testify that I have read this entire document and agree to be bound by it's terms. By applying my electronic signature to this agreement, whether on my own behalf and/or on the behalf of any minors, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable. By electronically signing and submitting this agreement, I 1) acknowledge that I have read and fully understand the terms of the agreement; 2) voluntarily agree to be bound by this agreement; and 3) certify that I am 18 years of age or older.
SUBMIT THIS SECTION

ALMOST DONE, KEEP GOING!