Fall Break 2019 - Yellowstone

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Please fill out this form, even if you have filled out other Sage Expeditions forms in the past. This is the easiest way for us to collect all of your information in case of an emergency.

We will leave on Monday, September 30th and spend the next four days exploring Yellowstone National Park. We will leave Friday, October 4th and return to Sage around 5:00pm. See website for details.

Student First Name *

Student Last Name *

Student Grade *

6th Grade

7th Grade

8th Grade

9th Grade

Primary Parent Contact (Full Name) *

Primary Parent Phone Number *

Primary Parent Email (please spell carefully) *

Secondary Parent or Contact (Full Name)

Secondary Phone Number

Does your child have any medical concerns or allergies we need to know about? If so, please explain and fill out Medication Form, if necessary. *

Health Insurance Company *

Primary Name on the Insurance Policy *

Policy Number *

Group Number *

Member ID Number *

Please submit the following to the front desk at Sage *

Signed Risk waiver (will be kept on file for the school year. Only need to submit once per academic year)

Copy of Medcation Form (If you're bringing medications)

If you are selected to participate, please submit $350 to the Sage front desk and put your student's name and "HS WW Raft" in the For line

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