Session 1 Registration - Summer 2022 - Cohort 1
This FREE program brings together a community of at-risk middle and high school-aged youth in order to support healing and build resiliency through Forest and Wilderness Therapy and various other multi-cultural healing modalities.

Join us for 4 weekends in July and a week-long immersion in August as we hike, write, move, meditate, draw, dream, sit in sacred Council circle, swim, sleep in tents by the river or on the trail, cook over the campfire, and partner with the more than human world to grow as individuals and as a community.

Dates are: July 8-10, July 15-17, July 22-24, July 29-31, August 7-13
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Camper Legal Name *
Camper Preferred Name *
Camper Preferred Pronouns *
Camper's Age *
Grade Camper will be entering in the Fall of 2022 *
Required
Camper Mailing Address *
Camper Physical Address (if different)
Camper Phone Number *
Camper E-mail Address *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent/Guardian E-mail Address *
Parent/Guardian Mailing Address *
Which School does the Camper Attend? *
What is the e-mail address of the school's guidance counselor? *
This program runs 4 weekends in July and for a week-long immersion in August. 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. Which dates can your camper commit to attending? *
Required
The Barra School has some funding to provide transportation to/from this program. Are you in need of transportation? If so, for which dates? *
Required
This program requires a moderate degree of physical fitness and the ability to traverse somewhat uneven, rocky, and steep terrain. Does your camper 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. *
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 4 brief google form surveys/feedback forms (prior to, during, immediately after, and 3 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 camper's primary care physician's information. We will only contact them in the event of an emergency. *
In the event of an emergency, who should we contact if we can not reach you directly? *
Does your camper have any medical needs or food allergies we should know about? If so, please explain. *
Is there any information about your camper 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 camper listed to attend our programming. *
Do you have any questions or concerns that you'd like to discuss with us? 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 Summer 2022 Inaugural Cohort. We can't wait to meet you and will be reaching out shortly to confirm your enrollment!
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