Student Name
*
First Name
Last Name
Student Email Address
*
Student Phone Number
*
(###)
###
####
What is your t-shirt size (student)?
*
XXS
XS
S
M
L
XL
XXL
XXXL
Parent or Guardian Name
*
First Name
Last Name
Parent or Guardian Phone Number
*
(###)
###
####
Additional Parent/Guardian Email Address
School Student Currently Attends
*
Student's Graduation Year
*
2021
2022
2023
2024
2025
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Have you ever participated in a WFSI trip?
*
No
Yes - Summer
Yes - Spring
Please list the high school science courses you have taken or are now taking, and indicate the year taken, semester grades, and teacher
*
Please list any science courses you plan to sign up for next year
*
Do you plan to pursue a college education?
*
Yes
No
Unsure
What are your career goals?
*
In what types of physical activities do you regularly participate?
*
If you answered yes, please explain.
Do you have a fear of swimming in the ocean?
*
Yes
No
Do you consider yourself a strong swimmer?
*
Yes
No
Do you have any allergies?
*
Yes
No
If you answered "yes" to having allergies, please list them, their severity, and your treatment plan
Do you sleepwalk or sleep talk?
*
Yes
No
Why do you want to be part of the WFSI 2020 California Trip?
*
What positive contributions will you make to the group?
*
How will you benefit or grow from participating in the trip?
*
This trip includes many hikes in which students will hike several miles at a steep incline with gear. Please explain what you will do in order to prepare yourself for this type of strenuous activity.
*
What will you do to prepare yourself mentally for this trip?
*
Please use this space to give us any additional information you think would be helpful for us to know about you.
Parent Agreement
*
I am aware that my daughter/son is interested in the Worthington Field Studies program. Likewise, I am aware of the total cost of the program ($2500), with the $100 deposit due upon application and the $600 non-refundable deposit due the night of the first meeting. I am aware that once this deposit is made, if for some reason my son/daughter is unable to take part in the Worthington Field Studies Program, all monies which have been paid up to that point in time are forfeited. I am also aware of the possibility that if my child breaks a serious school rule, he/she will be sent home at my expense. In such case, I am aware that all fees paid will be forfeited. I am aware that if my son/daughter is chosen for the trip and decides to return home during the trip, the costs associated with the return home of the student and an adult chaperone will be paid by me and no monies will be reimbursed.
My daughter/son has no mental or physical medical conditions that would enter into the selection process for this strenuous outdoor program. (If you have some question regarding your child's physical capability in regards to participation in this course, please include some explanation in an email to info@worthingtonfieldstudies.org)
If my child is not accepted into the Worthington Field Studies program, the $100 application deposit will be refunded.
