kidsonhill.jpg (13491 bytes)

                                       Taking a break above Twin Lakes in the Rattlesnake Wilderness Area

 

I want to register for a Wildlands Volunteer Corps Project!                                  

Our programs are first come-first served. The sooner you register, the likelier you are to get a spot.  Maximum number of participants is typically eight.

To register, you will need to do two things:

  1. Fill out both forms below (Registration and Health forms) and submit them both.
  2. If you attend Big Sky, Sentinel, Hellgate or Seeley/Swan, get a Flagship Permission Form from your Flagship Coordinator; fill it out and have your parents sign it. Turn it back in to the Flagship Coordinator! He/she will get a copy to us.

         **Once we have all three forms on file at Northwest Connections, you will be able to participate in your project of choice. If you attend a school other than the ones listed above, just submit the Registration and Health forms below.

        **If you have already turned in one or more of these forms, simply e-mail us at and tell us A) What you've already turned in; and B) Which project you want to participate in. We'll figure out what else you need to do and get back to you!

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Wildlands Volunteer Corps Registration Form

Your Name:

Your E-Mail address:

Your Snail Mail address:
Street Address:
City, State and Zip Code:

School you currently attend:

Current Age and Grade in School:

Dates of WVC Project you would like to register for:

 

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Health form

PARENTS: PLEASE ANSWER THE FOLLOWING QUESTIONS ACCURATELY AND TO THE BEST OF YOUR KNOWLEDGE

 Name of volunteer  

     1.  Please check "yes" if student has any of the following medical problems; otherwise, check "no."  If "yes," please provide any pertinent information about the condition in the comment box at the bottom of this form.  Checking "yes" to any of the following does not automatically disqualify an applicant from participation in the WVC!  However, we need to know as much as we can about students' health in order to best accommodate their needs.

YES          NO

           Epilepsy/seizures

           Asthma or other respiratory disorders

           Diabetes

           Heart Disease

           Fainting Disorders

           Bleeding Disorders

     2.  Does your child have any allergies?     YES          NO

     If yes, to what substance?

     What treatment does your child require for an allergic reaction?

     3.  Has your child had surgery in the past year?     YES     NO

If yes, describe the reason for the surgery and the outcome.

     4.  Has your child been hospitalized in the past year?     YES     NO

If yes, describe the reason for hospitalization and the outcome.

     5.  Are any medications prescribed for your child?     YES     NO

If yes, give the name of the medication and the reason for its prescription:

When does your child take this medication?

     6.  Please elaborate on any medical problems for which you checked "yes" above:

      7.  In the event of an emergency, the following information will help us provide your child with needed care:

Your medical insurance provider is:

Your policy number is:

If there is an emergency, whom should we contact?

Name Relationship

Address

Day phone:        Night phone: 

 

 Home
Sept 16-17
Oct 19-22
Nov10-12
Nov17-19
Dec15-17
Sign Me Up!
What to bring
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