Adventure Club - Free Range Registration Form

Use format mm/dd/yyyy
Enter child's age in years.
Ex: Lamplighter Montessori, Snowden Elementary, Homeschool, etc.
10 Digit Phone Number
Name and 10 Digit Phone Number
Name (first & last) and Phone Number
My child has permission to participate in Adventure Club, an enrichment program that may
include outdoor exploration, nature play, light hiking, climbing on natural features, group games, and other physically active activities held on or near school grounds.
I acknowledge that there is no on-site restroom at Urban Roots and that my child may need to use a private, designated outdoor area when needed.
I understand that activities may take place in wooded and natural areas that may include uneven ground, roots, rocks, mud, sticks, thorns, insects, and occasionally litter or debris such as broken glass or rusted materials. I give permission for my child to explore these spaces under supervision and understand that minor scrapes or bumps are a normal part of outdoor play.
I understand that Adventure Club may include supervised activities such as barefoot play, tree climbing, campfires, identifying and tasting edible plants, using age-appropriate tools, such as shovels and garden shears, and riding bicycles with proper safety gear. I give permission for my child to participate in these activities when deemed appropriate by the instructor.
I understand that participation in outdoor and physical activities involves inherent risks, including but not limited to falls, scrapes, insect bites, allergic reactions, weather exposure, interactions with the public, and other accidental injuries. I voluntarily accept and assume these risks.
In consideration of my child’s participation, I release and discharge Sydney Roberts and any assistants, volunteers, or instructors from liability for injuries, losses, or damages arising from participation, except in cases of gross negligence or willful misconduct.
I agree to indemnify and hold harmless Sydney Roberts from any claims, costs, damages, or expenses resulting from my child’s participation.
I authorize the instructor to provide basic first aid and address minor medical concerns that arise during Adventure Club. If I cannot be reached, I authorize the instructor to take reasonable steps to address the situation and seek medical care when reasonably necessary.
I agree to provide accurate and updated information regarding any medical conditions, allergies, medications, or special needs that may affect my child’s safety or participation.
Adventure Club is built on kindness, cooperation, and safe choices. If my child’s behavior creates a safety concern, the instructor may suspend them from Adventure Club for one week. If unsafe or disruptive behavior continues after suspension, the child may be dismissed from the program. Refunds are not guaranteed in cases of suspension or dismissal.
I understand that Adventure Club encourages children to develop independence, resilience, and problem-solving skills. My child is able, within reason, to self-regulate, work through minor frustrations, and resolve age-appropriate interpersonal problems with limited adult assistance. I understand that the instructor will provide support and guidance when needed, but my child should be able to recover from minor setbacks and continue participating with appropriate encouragement.
Activities may take place outdoors in varying weather conditions. I agree to provide appropriate clothing and understand that activities may be modified, relocated, or canceled if conditions are unsafe. Cancellations will not result in a refund, partial or otherwise.
I agree to pick up my child promptly at the designated time. Children will only be released to authorized individuals, and identification may be required at pickup.
I understand that all payments made for Adventure Club are non-refundable. No refunds, credits, or partial refunds will be issued for absences, illness, late enrollment withdrawal, suspension, dismissal, weather-related cancellations, schedule changes, or cancellation of an individual activity. By registering my child, I acknowledge and agree to this refund policy.
In consideration for participation in activities occurring at or in connection with Urban Roots of Tennessee, the undersigned parent or legal guardian, on behalf of themselves and the participating minor child, knowingly and voluntarily assumes all risks associated with participation and agrees, to the fullest extent permitted by law, to release, waive, discharge, indemnify, and hold harmless Urban Roots of Tennessee, Golden Gate Development Corporation, Golden Gate Cathedral, and each of their respective officers, directors, employees, agents, representatives, volunteers, affiliates, successors, and assigns from and against any and all claims, demands, liabilities, damages, losses, costs, or causes of action arising from or related to the participant’s involvement in the activities, including claims involving personal injury, illness, property damage or loss, permanent disability, or death, except to the extent prohibited by applicable law.
By entering my name above, I confirm that I am a legal guardian of the child who will be enrolled in Adventure Club, and I have read, understand, and voluntarily agree to this Participation Agreement Form.