2024 Right Tree Summer Adventures Registration Form

Participant first name *

Participant last name *

Participant street address *

Participant street address line 2

City *

Zip *

Participant phone number

Participant's grade next fall *

7th grade

8th grade

9th grade

other

Participant's birthday (mm.dd.yyyy) *

Registering parent/guardian's first name *

Registering parent/guardian's last name *

My home address is the same as above

Registering parent/guardian's home address if different from participant

Registering parent/guardian's email address

Daytime phone number *

NIght phone number *

All activities have a suggested donation amount.

This amount represents a small portion of the actual cost.

If you are able to donate, it will be very much appreciated.

Unless other arrangements have been made, please submit your donation no later than the first day of the activity.

*

Grab A Hammer/Freedom Builders, 2pm June 24-2pm June 28, Suggested donation $100

The Perfect Pair, 9am July 10-4pm July 11, Suggested donation: $40

Cedar Point, 10am July 23-5pm July 26, Suggested donation: $80

Backpacking the Porkies, 9am Aug 6-6pm Aug 11, + 1-5pm Aug 4. Suggested donation: $120

Suggested Donation Total *

I am able to pay this much *

I can give extra to sponsor other participants

Total *

Please contact me

I have questions about payment

I have questions about something else

Payment options *

I will pay with a check to Right Tree, P.O. Box 544, Elk Rapids, MI . 49629

I will pay with a credit card now

I will pay using the "donate" button at www.righttree.org

I would like to make other arrangements, please contact me

Credit card number

Expiration date (mm/yy)

Security code

Billing zip

The billing address for this card is:

the same as my home address above

the same as my mailing address above

Can the participant swim? *

yes

no

Is the participant comfortable swimming in water over her head? *

yes

no

What size adult shirt does the participant wear? *

Does the participant have any allergies (food or other) we should be aware of?

Does the participant have any medical conditions we should be aware of?

Is the participant taking any medication(s)? If so, what medication, dose, & frequency. Does she need assistance storing or taking her medication? Does she need a reminder of when to take it? Does it need to be refrigerated?

Is there anything else we should know about?

Emergency contact name (someone besides the registering adult) *

Emergency contact daytime phone *

Emergency contact night phone *

I recognize that certain hazards and dangers are inherent with Right Tree activities and programs and particularly, but limited to the activities of swimming, kayaking, stand up paddle boarding, bicycling, hiking, recreational competitions, the use of recreational equipment and power tools and being transported by Right Tree staff in corporate or personal vehicles. I acknowlege that although Right Tree has taken safety measures to minimize the risk to injury to participants, Right Tree cannot ensure nor guarantee that the equipment, premises, and/or activites will be free from hazards, accidents, and/or injuries. I further recognize the importance of the above named minor child knowing and abiding by the program's rules, regulations, and procedures for the safety of activity participants. I recognize any child may be asked to leave the pargram at the discretion of the program staff. In consideration of Right Tree, accepting and permitting the above named minor child to attend this program and participate in activities, I agree that Right Tree, a non-profit corporation, its agents, officers, employees, trustees and volunteers wil not be liable for any injury, death, damage and/or loss to me, the above named minor child, and/or anyone claiming on my or my child's behalf, and I will further agree to hold harmless, indemnify and defend Right Tree, its officers, agents, employees, trustees and volunteers for and from any and all damage during the time the above named minor child is a participant. I certify that any and all photography, videotape and digital images of the above named minor child participating in Right Tree programs are the sole property of Right Tree and give permission for them to be used, without compensation, at the sole discretion of Right Tree. By signing below I certify I am the parent or legal guardian named above for the minor child named above and I give my permission for said child to participate in Right Tree programs. I also certify I am under no mental or legal disability, which would prevent me from signing and executing this agreement. I further represent that I have read (or have had read to me) and understand the terms of this agreement.

Driver's license or MI ID number *

Today's date (mm/dd/yy) *

Signature of parent/guardian completing this form -- sign with mouse or finger *

clear

After you press the "submit" button below you will receive an acknowledgment message

if this form is still on your screen after pressing the button, it was not sent.