Winter/Spring 2022-23 Registration
This FREE program brings together a community of LGBTQIA+ middle and high school-aged youth in order to create community, support healing, and build resiliency through Forest and Wilderness Therapy, other multi-cultural healing modalities, and various team and community-building programming and activities. 

This winter we will be hiking out to various cabins and lodges, participating in winter outdoor activities, as well as journaling, meditating, playing games, sitting in Council circle, hanging out around a campfire, cooking meals together, and spending several weekends and vacation weeks together in community, friendship, and support. Adult mentors will guide youth through a sequence of resiliency-building programming, teach various skills, and support youth as they move through intentional and sequential programming. 
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Youth Participant's Legal Name *
Youth Participant's Preferred Name *
Youth Participant's Preferred Pronouns *
Youth Participant's Age *
Youth Participant's Grade SY 2022-23 *
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Youth Participant's Mailing Address *
Youth Participant's Physical Address (if different)
Youth Participant's Phone Number *
Youth Participant's E-mail Address *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent/Guardian E-mail Address *
Parent/Guardian Mailing Address *
Which School does the Youth Participant Attend? *
What is the e-mail address of the school's guidance counselor? *
Is your youth participant currently working with a therapist or psychologist? If so, can we contact them in regards to your youth's needs and/or progress in our program?
This program runs one or two weekends a month, as well as during school vacations. Following a cohort model, this program gives preference to enrolling youth who can attend all dates, though we won't turn away any youth who are interested some of our dates. 

Which dates can your youth commit to attending?
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The Barra School has funding to provide transportation to/from this program. Are you in need of transportation? If so, we will contact you directly regarding each program date you've registered for. *
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This program requires a moderate degree of physical fitness and the ability to traverse somewhat uneven, rocky, snowy, icy, and/or steep terrain. Does your youth have any barriers to participating in these activities or need any supports to do so successfully? *
If you have answered yes or maybe on the previous question please expand and explain your camper's situation here. *
The Barra School provides all group gear (backpacks, sleeping bags, sleeping pads, microspikes, snowshoes, safety equipment, and more) as well as any necessary clothing required for safe and equitable participation in our programming.  Please provide your youth participant's height, weight, and clothing/footwear sizes so we can be sure to have appropriate items in stock.
As part of our grant reporting and for the continuous improvement of this program and its services, we will be gathering survey data before, during, and after the program has completed in order to discern and document the impact it has had on the participants. We will use this data as general evidence of our program's success and to reflect on ways we can improve and expand our services. All participants and their families will be required to complete brief google form surveys/feedback forms (prior to, during, immediately after, and several months after the program's completion).  All information will be kept strictly confidential and survey data will be reported anonymously to protect privacy. Please type your name acknowledging that you consent to participate in this important process. *
Please provide your youth participant's primary care physician's information. We will only contact them in the event of an emergency. *
In the event of an emergency, please identify two individuals we should contact if we can not reach you directly. Please include names, phone numbers, addresses, and e-mail addresses.  *
In the event of a medical emergency, our staff are trained to respond and provide critical and supportive care, as well as complete any necessary rescue and evacuation. 

Please type your name here to consent to program-based medical care, including dispensing over-the-counter and prescription medications as outlined in the supplemental medical and release forms. 
We tailor or program food and activities based on participant need. Does your youth participant have any medical needs or food allergies we should know about? If so, please explain. *
Is there any information about your youth participant that we should know in order to best support them through this journey? *
Please type your name acknowledging that you've completed this form and give your permission for the youth participant listed to attend our programming. *
I recognize that my youth may not participate until I complete and sign the medical information, release, and waiver, and that participation in this program requires these documents be completed prior to the first outing my youth attends. 

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Do you have any questions or concerns that you'd like to discuss with us prior to your youth attending programming? If so, please list/outline/explain them here and we will reach out to you shortly to discuss them. *
Thank you for registering for the Winter and Spring of 2022-23 Cohort. We can't wait to meet you and will be reaching out shortly to gather more information and complete the enrollment process!
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