Student Name *
Student Name
Student Phone Number *
Student Phone Number
Parent or Guardian Name *
Parent or Guardian Name
Parent or Guardian Phone Number *
Parent or Guardian Phone Number
Address *
Rock climbing, hiking along ledges, hiking mountains
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 in January 2020. 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 If my child is not accepted into the Worthington Field Studies program, the $100 application deposit will be refunded.

A $100 deposit is due with application. Please purchase the item below in order for your application to be considered.

Student Application
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