Wild Medicine Heart

Nature Inspired Expressive Arts Programs

 

Registration & Offline Payment Options

To register, please complete and submit the following contact form.

To pay, please choose from the following options:

Check or money order: send to PO Box 212, Forestville, CA 95436.

Cash payment: please make arrangements directly with Nichole.

PayPal: paypal.me/NicholeLWarwick


Session Dates *
Please check the box(es) for the session(s) you are registering for.
Youth Name *
Youth Name
Parent/Guardian Name *
Parent/Guardian Name
Additional Parent/Guardian Name
Additional Parent/Guardian Name
Address *
Address
Phone *
Phone
Daytime/Mobile Phone *
Daytime/Mobile Phone
Emergency Contact *
Emergency Contact
In the event of an emergency, you authorize this person to make emergency medical decisions for your child:
Emergency Contact Phone Number *
Emergency Contact Phone Number
CONSENT *
By clicking this consent button, you hereby consent for your child to participate in the Wild Hearts Nature Inspired Expressive Arts Program operated by Nichole Warwick, and in activities connected with the arts program. You understand this is a nature-based arts experience, with inherent risks associated with use of art materials and playing in natural environments. You have notified Nichole Warwick of any medical conditions that may be relevant to a physician in the event of an emergency. You understand that Nichole Warwick does not provide medical insurance coverage for your child and that any medical expenses incurred on your child's behalf will be paid by either your own medical insurance or by you.
RELEASE *
By clicking this release button, you understand and hereby agree to assume all of the risks which may be encountered during said art and nature activities, including activities preliminary and subsequent thereto. You do hereby agree to hold Nichole Warwick, The REACH Charter School, and any agents and employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property which I now have or which may arise in the future in connection with the art program or participation in any other associated activities. You expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between parties hereto and the terms of this release are contractual and not a mere recital. You further state that YOU HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND AGREE TO THIS RELEASE AS YOUR OWN FREE ACT. This is a legally binding agreement that you have read and understand.
Payment *
Select your payment option.
Youth week-long sessions are $300 per week. All prices include art materials and a light snack. 10% discount for siblings/family. Limited scholarships and financial assistance available by request. Please enter your total amount below.
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