CHERRY HILLS VILLAGE ELEMENTARY SCHOOL

WILDERNESS EXPERIENCE

 ENROLLMENT APPLICATION

NAME OF PARTICIPANT: _________________________________________________________

NAME OF CLASSROOM TEACHER: ________________________________________________

M/F:  __________    AGE: _______________    BIRTHDATE: ___________________________

ADDRESS:  _____________________________________________________________________

CITY:  _________________________________________   STATE: _____   ZIP: _____________

PHYSICAL CONDITION:  __________________________________________________________

HEIGHT:  ______________________________    WEIGHT:  _____________________________

PARENT/LEGAL GUARDIAN NAME:  _______________________________________________

HOME PHONE:  (_______)________________   WORK PHONE:  (_______)______________

EMAIL: ________________________________________________________________________________

To be answered by the student:

1.           Why do you wish to participate in this course?

2.           What do you hope to learn during this experience?

3.           In one sentence describe what the word "wilderness" means to you.

Student Signature _____________________________________________  Date __________