Waitlist for Ermine Adventures Your Name * First Name Last Name Email * Phone * (###) ### #### Child's Name First Name Last Name Home Address Child's preferred gender Child's Birthday Please describe your child's health Dietary/restrictions/sensitivities/allergies and degree of severity, reactions, etc Alternative Emergency Contact Information Consider their personality traits, their strengths, and their challenges. What should I know about this young person to help them have the best experience possible? I respectfully request your consent to use participant photographs on my website YES/NO Preferred payment plan * Full payment $750 (save $45) 3 payments $265 (upon registraion, by Oct. 15, and by Dec. 15) Thank you!
