Youth Program Enrollment & Waiver

Sister Circle Fall Enrollment & Release of Liability Waiver

P.O. Box 57 • Sandpoint, ID 83864 • (208) 217-5788 • www.ritesofpassagesandpoint.com
Welcome to Sister Circle!

Fall Dates: Thursdays 3:15 - 5:15 Sep 24, October 1, 8, 15, 22, 29, and November 5. We are honored to include your daughter in our exceptional community of girls who are exploring nature and right relationship with self and other through play and adventure. Please register your daughter below by filling in the following information and signing the release of liability waiver. After your $50 deposit is received, you will be emailed an invoice for the remaining balance of $250 to complete your registration. Payment plans are also available, so please email contact@ritesofpassagesandpoint.com to request a payment plan. For scholarship application, see the link on the program page for Sister Circle on the ROPs website.
Participant Information
Participant Name

First NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tell us about your child. What strengths and challenges have your observed recently, especially in relational dynamics with self and other? Who are they most comfortable with? Please share from a holistic lense (emotional, physical, cognitive and spiritual):
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does participant have any allergies, recent injuries, chronic illness, or medical conditions? If yes, please describe.
What medications has your child been prescribed, and what meds does your child take regularly
PARTICIPANT RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS
ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

Please read and be certain you understand the implications of signing.
Express Assumption of Risk Associated with Youth Rites of Passage.
I, Name of Participant do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with Youth Programs of Mother Element LLC, dba Rites of Passage Sandpoint. Inherent hazards and risks of outdoor activities include, but are not limited to:
1. Risk of injury or death from exposure to flora and fauna in the wilderness.
2. Exposure to the elements and temperature extremes which may result in heat
exhaustion, heat stroke, sunburn, hypothermia and dehydration, inclement
weather, thunder and lightning, severe and/or varied wind, temperature and other
weather conditions.

*I understand the description of these risks is not complete and unknown or
unanticipated risks may result in injury or illness.

Release of Liability, Waiver of Claims and Indemnity Agreement
In consideration for being permitted to participate in the above described activity(ies) and related activities I HEREBY AGREE THAT I, MY SPOUSE, MY ASSIGNEES, HEIRS, GUARDIANS AND LEGAL REPRESENTATIVES WILL NOT MAKE A CLAIM AGAINST OR SUE Mother Element LLC, dba Rites of Passage Sandpoint ON ACCOUNT OF ANY AND ALL INJURY, or loss or damage to person or property, RESULTING FROM THE NEGLIGENCE OR OTHER ACTS, HOWSOEVER CAUSED BY Mother Element LLC, dba Rites of Passage Sandpoint.

This release shall by binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK
AGREEMENT, I FULLY UNDERSTAND ITS TERMS.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature

My Products

Sisters Circle Deposit Fall Session

Thursdays (Sep 24 - Nov 5) 7 weeks in Sandpoint, ID NON REFUNDABLE DEPOSIT. Once your enrollment is confirmed, you will receive an invoice for the remaining balance.

$50.00 Quantity

Total

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First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

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Sister Circle Fall Enrollment & Release of Liability Waiver

Welcome to Sister Circle!

Participant Information

My Products